Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE 15 MG TAB

Facility

$18.22

Service Code	NDC 51079008620
Hospital Charge Code	60628850
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.11
Rate for Payer: Aetna Commercial	$6.92
Rate for Payer: Aetna Medicare Advantage	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.65
Rate for Payer: Cigna Commercial	$9.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.47
Rate for Payer: Oxford Commercial	$3.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$3.64
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MIRTAZAPINE 30 MG ODT

Facility

$17.96

Service Code	NDC 66993071130
Hospital Charge Code	6063943266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.98
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.39
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MIRTAZAPINE 30 MG ODT

Facility

$17.96

Service Code	NDC 66993071130
Hospital Charge Code	6063943266
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

MIRTAZAPINE 30 MG TAB

Facility

$18.76

Service Code	NDC 51079008720
Hospital Charge Code	60628851
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.81

MIRTAZAPINE 30 MG TAB

Facility

$18.76

Service Code	NDC 51079008720
Hospital Charge Code	60628851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.38
Rate for Payer: Aetna Commercial	$7.13
Rate for Payer: Aetna Medicare Advantage	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.63
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$3.75
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$6.01
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$3.16
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$210.15
Max. Negotiated Rate	$4,360.00
Rate for Payer: Aetna Commercial	$3,313.60
Rate for Payer: Aetna Medicare Advantage	$2,616.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,223.60
Rate for Payer: Cigna Commercial	$4,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,918.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00
Rate for Payer: UnitedHealthcare Community & State	$210.15
Rate for Payer: Wellpoint Medicaid Managed Care	$231.08

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.00
Max. Negotiated Rate	$2,110.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,918.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$45,302.87

Service Code	MSDRG 640
Min. Negotiated Rate	$13,794.14
Max. Negotiated Rate	$45,302.87
Rate for Payer: Aetna Commercial	$31,385.57
Rate for Payer: Aetna Medicare Advantage	$45,302.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,704.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,704.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,520.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,704.52
Rate for Payer: Cigna Commercial	$24,994.42
Rate for Payer: Cigna Medicare Advantage	$14,520.15
Rate for Payer: Clover Medicare Advantage	$13,794.14
Rate for Payer: EmblemHealth Commercial	$43,560.45
Rate for Payer: Humana Medicare Advantage	$14,955.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,520.15
Rate for Payer: Oxford Commercial	$17,963.82
Rate for Payer: UnitedHealthcare Commercial	$31,500.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,520.15
Rate for Payer: Wellcare Medicare Advantage	$14,520.15

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$27,286.80

Service Code	MSDRG 641
Min. Negotiated Rate	$8,308.48
Max. Negotiated Rate	$27,286.80
Rate for Payer: Aetna Commercial	$19,006.47
Rate for Payer: Aetna Medicare Advantage	$27,286.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,745.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,143.58
Rate for Payer: Cigna Commercial	$14,563.23
Rate for Payer: Cigna Medicare Advantage	$8,745.77
Rate for Payer: Clover Medicare Advantage	$8,308.48
Rate for Payer: EmblemHealth Commercial	$26,237.31
Rate for Payer: Humana Medicare Advantage	$9,008.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,745.77
Rate for Payer: Oxford Commercial	$10,466.79
Rate for Payer: UnitedHealthcare Commercial	$18,353.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,745.77
Rate for Payer: Wellcare Medicare Advantage	$8,745.77

MISCELLANEOUS TRANS PROCEDURE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100189
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MISCELLANEOUS TRANS PROCEDURE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100189
Hospital Revenue Code	300
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

MIS HANDPIECE W AO MODULE

Facility

$5,880.00

Hospital Charge Code	270704003
Hospital Revenue Code	279
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$2,234.40
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.00
Rate for Payer: Oxford Commercial	$1,176.00
Rate for Payer: Qualcare PPO/HMO/WC	$882.00
Rate for Payer: UnitedHealthcare Commercial	$1,176.00
Rate for Payer: UnitedHealthcare Community & State	$141.71
Rate for Payer: Wellpoint Medicaid Managed Care	$155.82

MIS HANDPIECE W AO MODULE

Facility

$5,880.00

Hospital Charge Code	270704003
Hospital Revenue Code	279
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$882.00
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

MIS IRRIGATION KIT

Facility

$630.00

Hospital Charge Code	270704188
Hospital Revenue Code	279
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

MIS IRRIGATION KIT

Facility

$630.00

Hospital Charge Code	270704188
Hospital Revenue Code	279
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.00
Rate for Payer: Oxford Commercial	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Commercial	$126.00
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

Know your out-of-pocket cost for care.

All Charges