Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$19.79
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.20
Rate for Payer: Aetna Commercial	$16.12
Rate for Payer: Aetna Medicare Advantage	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.81
Rate for Payer: Cigna Commercial	$21.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.72
Rate for Payer: Oxford Commercial	$8.48
Rate for Payer: Qualcare PPO/HMO/WC	$6.36
Rate for Payer: UnitedHealthcare Commercial	$8.48
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$6.36
Rate for Payer: Qualcare PPO/HMO/WC	$6.36

MIDAZOLAM 5MG/5ML

Facility

$13.65

Hospital Charge Code	60635792
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

MIDAZOLAM 5MG/5ML

Facility

$13.65

Hospital Charge Code	60635792
Hospital Revenue Code	636
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

MIDAZOLAM 5 MG/5 ML VIAL

Facility

$12.06

Service Code	HCPCS J2250
Hospital Charge Code	6008726
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

MIDAZOLAM 5 MG/5 ML VIAL

Facility

$12.06

Service Code	HCPCS J2250
Hospital Charge Code	6008726
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

MIDAZOLAM 5MG/ML 10ML

Facility

$75.00

Hospital Charge Code	60635759
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MIDAZOLAM 5MG/ML 10ML

Facility

$75.00

Hospital Charge Code	60635759
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.31
Rate for Payer: Aetna Commercial	$16.96
Rate for Payer: Aetna Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.38
Rate for Payer: Cigna Commercial	$22.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.63
Rate for Payer: Aetna Commercial	$2.76
Rate for Payer: Aetna Medicare Advantage	$2.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$16.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.51
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.60
Rate for Payer: Cigna Commercial	$34.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

MIDAZOLAM IVCI 5MG/50ML

Facility

$62.75

Hospital Charge Code	60628651
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.38
Rate for Payer: Aetna Commercial	$23.84
Rate for Payer: Aetna Medicare Advantage	$18.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.00
Rate for Payer: Cigna Commercial	$31.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.82
Rate for Payer: Oxford Commercial	$12.55
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Commercial	$12.55
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

MIDAZOLAM IVCI 5MG/50ML

Facility

$62.75

Hospital Charge Code	60628651
Hospital Revenue Code	250
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$9.41
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

MIDAZOLAN

Facility

$47.35

Hospital Charge Code	270656759
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

MIDAZOLAN

Facility

$47.35

Hospital Charge Code	270656759
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$90.88
Rate for Payer: Aetna Commercial	$69.06
Rate for Payer: Aetna Medicare Advantage	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.35
Rate for Payer: Cigna Commercial	$90.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26
Rate for Payer: UnitedHealthcare Community & State	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$43.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26

MIDFOOT FUSU-PLT RT ORT 3DI PL

Facility

$22,036.85

Service Code	HCPCS C1713
Hospital Charge Code	270703974
Hospital Revenue Code	278
Min. Negotiated Rate	$531.09
Max. Negotiated Rate	$11,018.42
Rate for Payer: Aetna Commercial	$8,374.00
Rate for Payer: Aetna Medicare Advantage	$6,611.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,619.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,619.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,407.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,619.40
Rate for Payer: Cigna Commercial	$11,018.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,332.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,848.11
Rate for Payer: Qualcare PPO/HMO/WC	$3,305.53
Rate for Payer: UnitedHealthcare Community & State	$531.09
Rate for Payer: Wellpoint Medicaid Managed Care	$583.98

MIDFOOT FUSU-PLT RT ORT 3DI PL

Facility

$22,036.85

Service Code	HCPCS C1713
Hospital Charge Code	270703974
Hospital Revenue Code	278
Min. Negotiated Rate	$3,305.53
Max. Negotiated Rate	$5,332.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,407.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,332.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,848.11
Rate for Payer: Qualcare PPO/HMO/WC	$3,305.53

MIDODRINE 10MGTAB

Facility

$33.37

Service Code	NDC 50268056615
Hospital Charge Code	60635680
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$5.01
Rate for Payer: Qualcare PPO/HMO/WC	$5.01

MIDODRINE 10MGTAB

Facility

$33.37

Service Code	NDC 50268056615
Hospital Charge Code	60635680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.68
Rate for Payer: Aetna Commercial	$12.68
Rate for Payer: Aetna Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.51
Rate for Payer: Cigna Commercial	$16.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.01
Rate for Payer: Oxford Commercial	$6.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.01
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

Know your out-of-pocket cost for care.

All Charges