Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

MISOPROSTOL 100 MCG TAB

Facility

$7.75

Hospital Charge Code	60628168
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.94
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

MISOPROSTOL 100 MCG TAB

Facility

$7.75

Hospital Charge Code	60628168
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

MISOPROSTOL 200 MCG TAB

Facility

$7.25

Hospital Charge Code	60628169
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MISOPROSTOL 200 MCG TAB

Facility

$7.25

Hospital Charge Code	60628169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
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	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$31.34
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$494.19
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.15
Rate for Payer: Oxford Commercial	$260.10
Rate for Payer: Qualcare PPO/HMO/WC	$195.07
Rate for Payer: UnitedHealthcare Commercial	$260.10
Rate for Payer: UnitedHealthcare Community & State	$31.34
Rate for Payer: Wellpoint Medicaid Managed Care	$34.46

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$195.07
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$1,971.00
Rate for Payer: Aetna Commercial	$1,497.96
Rate for Payer: Aetna Medicare Advantage	$1,182.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.21
Rate for Payer: Cigna Commercial	$1,971.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.60
Rate for Payer: Oxford Commercial	$788.40
Rate for Payer: Qualcare PPO/HMO/WC	$591.30
Rate for Payer: UnitedHealthcare Commercial	$788.40
Rate for Payer: UnitedHealthcare Community & State	$95.00
Rate for Payer: Wellpoint Medicaid Managed Care	$104.46

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$591.30
Rate for Payer: Qualcare PPO/HMO/WC	$591.30

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$31.34
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$494.19
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.11
Rate for Payer: Qualcare PPO/HMO/WC	$195.07
Rate for Payer: UnitedHealthcare Community & State	$31.34
Rate for Payer: Wellpoint Medicaid Managed Care	$34.46

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$314.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.11
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2,407.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.35
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.67
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

MITHRACIN/2500MCG

Facility

$414.00

Hospital Charge Code	60633441
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

MITHRACIN/2500MCG

Facility

$414.00

Hospital Charge Code	60633441
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

MITHRAMYCIN INJ 2.5MG

Facility

$552.35

Hospital Charge Code	6015077
Hospital Revenue Code	636
Min. Negotiated Rate	$82.85
Max. Negotiated Rate	$133.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.85

MITHRAMYCIN INJ 2.5MG

Facility

$552.35

Hospital Charge Code	6015077
Hospital Revenue Code	636
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$276.18
Rate for Payer: Aetna Commercial	$209.89
Rate for Payer: Aetna Medicare Advantage	$165.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.85
Rate for Payer: Cigna Commercial	$276.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.85
Rate for Payer: UnitedHealthcare Community & State	$13.31
Rate for Payer: Wellpoint Medicaid Managed Care	$14.64

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

Know your out-of-pocket cost for care.

All Charges