Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MICROWICK SILVERSTEIN 0T-1700

Facility

$450.00

Hospital Charge Code	270647471
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

MICROWICK SILVERSTEIN 0T-1700

Facility

$450.00

Hospital Charge Code	270647471
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MICU AMBULANCE

Facility

$981.15

Hospital Charge Code	1100015
Hospital Revenue Code	540
Min. Negotiated Rate	$147.17
Max. Negotiated Rate	$147.17
Rate for Payer: Qualcare PPO/HMO/WC	$147.17

MICU AMBULANCE

Facility

$981.15

Hospital Charge Code	1100015
Hospital Revenue Code	540
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$372.84
Rate for Payer: Aetna Medicare Advantage	$294.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.19
Rate for Payer: Cigna Commercial	$490.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.35
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.17
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$23.65
Rate for Payer: Wellpoint Medicaid Managed Care	$26.00

MIDAMOR/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633430
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MIDAMOR/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633430
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Midazalam 2mg/ml syrup

Facility

$6.27

Hospital Charge Code	6062893
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.94

Midazalam 2mg/ml syrup

Facility

$6.27

Hospital Charge Code	6062893
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.38
Rate for Payer: Aetna Medicare Advantage	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.60
Rate for Payer: Cigna Commercial	$3.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.88
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.94
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

MIDAZOLAM 100MG/100ML NACL

Facility

$225.12

Service Code	HCPCS J2250
Hospital Charge Code	60630239
Hospital Revenue Code	636
Min. Negotiated Rate	$33.77
Max. Negotiated Rate	$54.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77

MIDAZOLAM 100MG/100ML NACL

Facility

$225.12

Service Code	HCPCS J2250
Hospital Charge Code	60630239
Hospital Revenue Code	636
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.56
Rate for Payer: Aetna Commercial	$85.55
Rate for Payer: Aetna Medicare Advantage	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.41
Rate for Payer: Cigna Commercial	$112.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$11.86
Rate for Payer: Aetna Commercial	$9.01
Rate for Payer: Aetna Medicare Advantage	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.05
Rate for Payer: Cigna Commercial	$11.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

MIDAZOLAM 2MG/ML 10ML LIQUID

Facility

$42.80

Hospital Charge Code	60629299
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.42

MIDAZOLAM 2MG/ML 10ML LIQUID

Facility

$42.80

Hospital Charge Code	60629299
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.40
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Medicare Advantage	$12.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.91
Rate for Payer: Cigna Commercial	$21.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.84
Rate for Payer: Oxford Commercial	$8.56
Rate for Payer: Qualcare PPO/HMO/WC	$6.42
Rate for Payer: UnitedHealthcare Commercial	$8.56
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

MIDAZOLAM 2MG/ML SYR ORAL

Facility

$750.25

Hospital Charge Code	6000468
Hospital Revenue Code	636
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$375.12
Rate for Payer: Aetna Commercial	$285.10
Rate for Payer: Aetna Medicare Advantage	$225.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.31
Rate for Payer: Cigna Commercial	$375.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.56
Rate for Payer: Qualcare PPO/HMO/WC	$112.54
Rate for Payer: UnitedHealthcare Community & State	$18.08
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

MIDAZOLAM 2MG/ML SYR ORAL

Facility

$750.25

Hospital Charge Code	6000468
Hospital Revenue Code	636
Min. Negotiated Rate	$112.54
Max. Negotiated Rate	$181.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.56
Rate for Payer: Qualcare PPO/HMO/WC	$112.54

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$5.50
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.34
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$24.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.45
Rate for Payer: Aetna Commercial	$39.11
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$51.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$26.52
Rate for Payer: Qualcare PPO/HMO/WC	$26.52

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$67.19
Rate for Payer: Aetna Medicare Advantage	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.09
Rate for Payer: Cigna Commercial	$88.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.04
Rate for Payer: Oxford Commercial	$35.36
Rate for Payer: Qualcare PPO/HMO/WC	$26.52
Rate for Payer: UnitedHealthcare Commercial	$35.36
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$65.95
Rate for Payer: Aetna Commercial	$50.12
Rate for Payer: Aetna Medicare Advantage	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.63
Rate for Payer: Cigna Commercial	$65.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.57
Rate for Payer: Oxford Commercial	$26.38
Rate for Payer: Qualcare PPO/HMO/WC	$19.79
Rate for Payer: UnitedHealthcare Commercial	$26.38
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

Know your out-of-pocket cost for care.

All Charges