Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOUNT TRANSDUCER POLE

Facility

$100.00

Hospital Charge Code	2709006570
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MOUNT TRANSDUCER POLE

Facility

$100.00

Hospital Charge Code	2709006570
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

MOUTHGUARD DISP 69100

Facility

$11.72

Hospital Charge Code	270601185
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.86
Rate for Payer: Aetna Commercial	$4.45
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.99
Rate for Payer: Cigna Commercial	$5.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.52
Rate for Payer: Oxford Commercial	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.34
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

MOUTHGUARD DISP 69100

Facility

$11.72

Hospital Charge Code	270601185
Hospital Revenue Code	270
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

MOUTHGUARD ENDOGARD***

Facility

$12.00

Hospital Charge Code	2300622
Hospital Revenue Code	279
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

MOUTHGUARD ENDOGARD***

Facility

$12.00

Hospital Charge Code	2300622
Hospital Revenue Code	279
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

MOUTHGUARD RUBBER EMGD

Facility

$181.65

Hospital Charge Code	270616361
Hospital Revenue Code	270
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

MOUTHGUARD RUBBER EMGD

Facility

$181.65

Hospital Charge Code	270616361
Hospital Revenue Code	270
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$90.83
Rate for Payer: Aetna Commercial	$69.03
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$36.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$36.33
Rate for Payer: UnitedHealthcare Community & State	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

MOUTHPIECE CARDBRD 022417

Facility

$2.45

Hospital Charge Code	270606149
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

MOUTHPIECE CARDBRD 022417

Facility

$2.45

Hospital Charge Code	270606149
Hospital Revenue Code	272
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

MOUTHPIECE TUBING 7FT. 02

Facility

$5.31

Hospital Charge Code	270648269
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.02
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.59
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

MOUTHPIECE TUBING 7FT. 02

Facility

$5.31

Hospital Charge Code	270648269
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

MOUTH PROCEDURES WITH CC/MCC

Facility

$50,396.77

Service Code	MSDRG 137
Min. Negotiated Rate	$15,345.17
Max. Negotiated Rate	$50,396.77
Rate for Payer: Aetna Commercial	$34,885.65
Rate for Payer: Aetna Medicare Advantage	$50,396.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,891.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,891.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,152.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,891.50
Rate for Payer: Cigna Commercial	$27,943.74
Rate for Payer: Cigna Medicare Advantage	$16,152.81
Rate for Payer: Clover Medicare Advantage	$15,345.17
Rate for Payer: EmblemHealth Commercial	$48,458.43
Rate for Payer: Humana Medicare Advantage	$16,637.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,152.81
Rate for Payer: Oxford Commercial	$20,083.54
Rate for Payer: UnitedHealthcare Commercial	$35,217.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,152.81
Rate for Payer: Wellcare Medicare Advantage	$16,152.81

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$30,777.55

Service Code	MSDRG 138
Min. Negotiated Rate	$9,371.37
Max. Negotiated Rate	$30,777.55
Rate for Payer: Aetna Commercial	$21,405.01
Rate for Payer: Aetna Medicare Advantage	$30,777.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,237.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,237.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,864.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,237.07
Rate for Payer: Cigna Commercial	$16,584.35
Rate for Payer: Cigna Medicare Advantage	$9,864.60
Rate for Payer: Clover Medicare Advantage	$9,371.37
Rate for Payer: EmblemHealth Commercial	$29,593.80
Rate for Payer: Humana Medicare Advantage	$10,160.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,864.60
Rate for Payer: Oxford Commercial	$11,919.39
Rate for Payer: UnitedHealthcare Commercial	$20,901.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,864.60
Rate for Payer: Wellcare Medicare Advantage	$9,864.60

MOUTHWASH APRILFRESH

Facility

$4.00

Hospital Charge Code	270301253
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MOUTHWASH APRILFRESH

Facility

$4.00

Hospital Charge Code	270301253
Hospital Revenue Code	270
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MOXAN PLATE

Facility

$11,455.00

Hospital Charge Code	270656605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,718.25
Max. Negotiated Rate	$2,772.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,520.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25

MOXAN PLATE

Facility

$11,455.00

Hospital Charge Code	270656605
Hospital Revenue Code	278
Min. Negotiated Rate	$276.07
Max. Negotiated Rate	$5,727.50
Rate for Payer: Aetna Commercial	$4,352.90
Rate for Payer: Aetna Medicare Advantage	$3,436.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,921.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,921.03
Rate for Payer: Cigna Commercial	$5,727.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,520.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,718.25
Rate for Payer: UnitedHealthcare Community & State	$276.07
Rate for Payer: Wellpoint Medicaid Managed Care	$303.56

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.56
Rate for Payer: Aetna Commercial	$111.39
Rate for Payer: Aetna Medicare Advantage	$87.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.75
Rate for Payer: Cigna Commercial	$146.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$70.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$33.41

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$111.36
Rate for Payer: Aetna Commercial	$84.63
Rate for Payer: Aetna Medicare Advantage	$66.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.79
Rate for Payer: Cigna Commercial	$111.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.81
Rate for Payer: Oxford Commercial	$44.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.41
Rate for Payer: UnitedHealthcare Commercial	$44.54
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
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	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges