Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MIDODRINE 2.5 MG TAB

Facility

$17.76

Service Code	NDC 50268056415
Hospital Charge Code	60628534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.88
Rate for Payer: Aetna Commercial	$6.75
Rate for Payer: Aetna Medicare Advantage	$5.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.53
Rate for Payer: Cigna Commercial	$8.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.66
Rate for Payer: UnitedHealthcare Commercial	$3.55
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

MIDODRINE 2.5 MG TAB

Facility

$17.76

Service Code	NDC 50268056415
Hospital Charge Code	60628534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.66

MIDODRINE 5 MG TAB

Facility

$27.87

Service Code	NDC 245021211
Hospital Charge Code	60628653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.94
Rate for Payer: Aetna Commercial	$10.59
Rate for Payer: Aetna Medicare Advantage	$8.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.11
Rate for Payer: Cigna Commercial	$13.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.36
Rate for Payer: Oxford Commercial	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$5.57
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

MIDODRINE 5 MG TAB

Facility

$27.87

Service Code	NDC 245021211
Hospital Charge Code	60628653
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

MIDODRINE 5 MG TAB

Facility

$15.40

Hospital Charge Code	60628653R
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

MIDODRINE 5 MG TAB

Facility

$15.40

Hospital Charge Code	60628653R
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

MIDODRINE TAB 2.5MG

Facility

$7.70

Hospital Charge Code	60628652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MIDODRINE TAB 2.5MG

Facility

$7.70

Hospital Charge Code	60628652
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

MIDOS REX BUR AM-8 14-AM

Facility

$926.25

Hospital Charge Code	270663922
Hospital Revenue Code	270
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$463.12
Rate for Payer: Aetna Commercial	$351.98
Rate for Payer: Aetna Medicare Advantage	$277.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.19
Rate for Payer: Cigna Commercial	$463.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.88
Rate for Payer: Oxford Commercial	$185.25
Rate for Payer: Qualcare PPO/HMO/WC	$138.94
Rate for Payer: UnitedHealthcare Commercial	$185.25
Rate for Payer: UnitedHealthcare Community & State	$22.32
Rate for Payer: Wellpoint Medicaid Managed Care	$24.55

MIDOS REX BUR AM-8 14-AM

Facility

$926.25

Hospital Charge Code	270663922
Hospital Revenue Code	270
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$138.94
Rate for Payer: Qualcare PPO/HMO/WC	$138.94

MID-PHALANX FUSION IMPLT.NEXA

Facility

$340.00

Hospital Charge Code	270339448
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

MID-PHALANX FUSION IMPLT.NEXA

Facility

$340.00

Hospital Charge Code	270339448
Hospital Revenue Code	278
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

MI-EYE DISP NEEDLESCOPE 95MM

Facility

$3,475.00

Hospital Charge Code	270697110
Hospital Revenue Code	272
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$521.25
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

MI-EYE DISP NEEDLESCOPE 95MM

Facility

$3,475.00

Hospital Charge Code	270697110
Hospital Revenue Code	272
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.50
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Commercial	$695.00
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

MIGRAINE AND OTHER HEADACHES

Facility

$17,232.99

Service Code	APR-DRG 0544
Min. Negotiated Rate	$16,895.09
Max. Negotiated Rate	$17,232.99
Rate for Payer: UnitedHealthcare Community & State	$16,895.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,232.99
Rate for Payer: Wellpoint Medicaid Managed Care	$16,895.09

MIGRAINE AND OTHER HEADACHES

Facility

$10,525.18

Service Code	APR-DRG 0543
Min. Negotiated Rate	$10,318.80
Max. Negotiated Rate	$10,525.18
Rate for Payer: UnitedHealthcare Community & State	$10,318.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,525.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10,318.80

MIGRAINE AND OTHER HEADACHES

Facility

$8,348.37

Service Code	APR-DRG 0542
Min. Negotiated Rate	$8,184.68
Max. Negotiated Rate	$8,348.37
Rate for Payer: UnitedHealthcare Community & State	$8,184.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,348.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8,184.68

MIGRAINE AND OTHER HEADACHES

Facility

$6,984.91

Service Code	APR-DRG 0541
Min. Negotiated Rate	$6,847.95
Max. Negotiated Rate	$6,984.91
Rate for Payer: UnitedHealthcare Community & State	$6,847.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,984.91
Rate for Payer: Wellpoint Medicaid Managed Care	$6,847.95

MIGRAINE TREATMENT

Facility

$2,793.75

Hospital Charge Code	1001165
Hospital Revenue Code	360
Min. Negotiated Rate	$67.33
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,061.62
Rate for Payer: Aetna Medicare Advantage	$838.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.41
Rate for Payer: Cigna Commercial	$1,396.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$838.12
Rate for Payer: Qualcare PPO/HMO/WC	$419.06
Rate for Payer: UnitedHealthcare Community & State	$67.33
Rate for Payer: Wellpoint Medicaid Managed Care	$74.03

MIGRAINE TREATMENT

Facility

$2,793.75

Hospital Charge Code	1001165
Hospital Revenue Code	360
Min. Negotiated Rate	$419.06
Max. Negotiated Rate	$419.06
Rate for Payer: Qualcare PPO/HMO/WC	$419.06

MILAGRO ADVANCE SCREW 9 X 30MM

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270663885
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$538.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

MILAGRO ADVANCE SCREW 9 X 30MM

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270663885
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

MILAGRO BR INTERFERENCE SCREW

Facility

$2,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270679989
Hospital Revenue Code	278
Min. Negotiated Rate	$60.01
Max. Negotiated Rate	$1,245.00
Rate for Payer: Aetna Commercial	$946.20
Rate for Payer: Aetna Medicare Advantage	$747.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$634.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$634.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$634.95
Rate for Payer: Cigna Commercial	$1,245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$602.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$547.80
Rate for Payer: Qualcare PPO/HMO/WC	$373.50
Rate for Payer: UnitedHealthcare Community & State	$60.01
Rate for Payer: Wellpoint Medicaid Managed Care	$65.98

MILAGRO BR INTERFERENCE SCREW

Facility

$2,490.00

Service Code	HCPCS C1713
Hospital Charge Code	270679989
Hospital Revenue Code	278
Min. Negotiated Rate	$373.50
Max. Negotiated Rate	$602.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$602.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$547.80
Rate for Payer: Qualcare PPO/HMO/WC	$373.50

MILAGRO SCREW 10MM X 30MM

Facility

$1,950.00

Hospital Charge Code	270658625
Hospital Revenue Code	278
Min. Negotiated Rate	$46.99
Max. Negotiated Rate	$975.00
Rate for Payer: Aetna Commercial	$741.00
Rate for Payer: Aetna Medicare Advantage	$585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.25
Rate for Payer: Cigna Commercial	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$429.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.50
Rate for Payer: UnitedHealthcare Community & State	$46.99
Rate for Payer: Wellpoint Medicaid Managed Care	$51.67

Know your out-of-pocket cost for care.

All Charges