Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MINTEZOL/500MG/5ML

Facility

$89.00

Hospital Charge Code	60633439
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

MINTEZOL/500MG/5ML

Facility

$89.00

Hospital Charge Code	60633439
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

MINTEZOL/500MG/TAB

Facility

$6.00

Hospital Charge Code	60633438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MINTEZOL/500MG/TAB

Facility

$6.00

Hospital Charge Code	60633438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

MIOCHOL 1% OPHTH/2ML

Facility

$131.00

Hospital Charge Code	60633440
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

MIOCHOL 1% OPHTH/2ML

Facility

$131.00

Hospital Charge Code	60633440
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

MIO MEDICAL DEVICE ORGANIZER

Facility

$86.67

Hospital Charge Code	270658155
Hospital Revenue Code	270
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$43.34
Rate for Payer: Aetna Commercial	$32.93
Rate for Payer: Aetna Medicare Advantage	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.10
Rate for Payer: Cigna Commercial	$43.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$13.00
Rate for Payer: UnitedHealthcare Commercial	$17.33
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.30

MIO MEDICAL DEVICE ORGANIZER

Facility

$86.67

Hospital Charge Code	270658155
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.00

MIOSTAT 0.01% SDV

Facility

$236.91

Service Code	NDC 65002315
Hospital Charge Code	606390042
Hospital Revenue Code	250
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$118.45
Rate for Payer: Aetna Commercial	$90.03
Rate for Payer: Aetna Medicare Advantage	$71.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.41
Rate for Payer: Cigna Commercial	$118.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.07
Rate for Payer: Oxford Commercial	$47.38
Rate for Payer: Qualcare PPO/HMO/WC	$35.54
Rate for Payer: UnitedHealthcare Commercial	$47.38
Rate for Payer: UnitedHealthcare Community & State	$5.71
Rate for Payer: Wellpoint Medicaid Managed Care	$6.28

MIOSTAT 0.01% SDV

Facility

$236.91

Service Code	NDC 65002315
Hospital Charge Code	606390042
Hospital Revenue Code	250
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$35.54
Rate for Payer: Qualcare PPO/HMO/WC	$35.54

MIRACLE MOUTHWASH

Facility

$294.80

Service Code	NDC 10223030101
Hospital Charge Code	60635521
Hospital Revenue Code	250
Min. Negotiated Rate	$44.22
Max. Negotiated Rate	$44.22
Rate for Payer: Qualcare PPO/HMO/WC	$44.22

MIRACLE MOUTHWASH

Facility

$294.80

Service Code	NDC 10223030101
Hospital Charge Code	60635521
Hospital Revenue Code	250
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$147.40
Rate for Payer: Aetna Commercial	$112.02
Rate for Payer: Aetna Medicare Advantage	$88.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.17
Rate for Payer: Cigna Commercial	$147.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.44
Rate for Payer: Oxford Commercial	$58.96
Rate for Payer: Qualcare PPO/HMO/WC	$44.22
Rate for Payer: UnitedHealthcare Commercial	$58.96
Rate for Payer: UnitedHealthcare Community & State	$7.10
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

MIRALAX PWD 17GM

Facility

$9.00

Hospital Charge Code	60635544
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

MIRALAX PWD 17GM

Facility

$9.00

Hospital Charge Code	60635544
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

MIRAPEX 1.5MG TAB

Facility

$7.00

Hospital Charge Code	60635192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MIRAPEX 1.5MG TAB

Facility

$7.00

Hospital Charge Code	60635192
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MIRAPEX 1MG TAB

Facility

$19.77

Service Code	NDC 13668009490
Hospital Charge Code	60635193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$7.51
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.93
Rate for Payer: Oxford Commercial	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.95
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

MIRAPEX 1MG TAB

Facility

$19.77

Service Code	NDC 13668009490
Hospital Charge Code	60635193
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

MIRCO CLIPS SUERFINE TITANIUM

Facility

$54.17

Hospital Charge Code	270663933
Hospital Revenue Code	270
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$27.09
Rate for Payer: Aetna Commercial	$20.58
Rate for Payer: Aetna Medicare Advantage	$16.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.81
Rate for Payer: Cigna Commercial	$27.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$10.83
Rate for Payer: Qualcare PPO/HMO/WC	$8.13
Rate for Payer: UnitedHealthcare Commercial	$10.83
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

MIRCO CLIPS SUERFINE TITANIUM

Facility

$54.17

Hospital Charge Code	270663933
Hospital Revenue Code	270
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$8.13
Rate for Payer: Qualcare PPO/HMO/WC	$8.13

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	87502785
Hospital Revenue Code	278
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$356.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$323.73
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	87502785
Hospital Revenue Code	278
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$735.75
Rate for Payer: Aetna Commercial	$559.17
Rate for Payer: Aetna Medicare Advantage	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.23
Rate for Payer: Cigna Commercial	$735.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$323.73
Rate for Payer: Qualcare PPO/HMO/WC	$220.72
Rate for Payer: UnitedHealthcare Community & State	$35.46
Rate for Payer: Wellpoint Medicaid Managed Care	$38.99

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	270677501
Hospital Revenue Code	636
Min. Negotiated Rate	$220.72
Max. Negotiated Rate	$356.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72

MIRENA IUD

Facility

$1,471.50

Service Code	HCPCS J7298
Hospital Charge Code	270677501
Hospital Revenue Code	636
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$735.75
Rate for Payer: Aetna Commercial	$559.17
Rate for Payer: Aetna Medicare Advantage	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.23
Rate for Payer: Cigna Commercial	$735.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.10
Rate for Payer: Qualcare PPO/HMO/WC	$220.72
Rate for Payer: UnitedHealthcare Community & State	$35.46
Rate for Payer: Wellpoint Medicaid Managed Care	$38.99

MIRTAZAPINE 15 MG TAB

Facility

$18.22

Service Code	NDC 51079008620
Hospital Charge Code	60628850
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

Know your out-of-pocket cost for care.

All Charges