Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MYCOPHENOLATE 500 MG INJ

Facility

$730.70

Service Code	NDC 4029809
Hospital Charge Code	60635437
Hospital Revenue Code	250
Min. Negotiated Rate	$17.61
Max. Negotiated Rate	$365.35
Rate for Payer: Aetna Commercial	$277.67
Rate for Payer: Aetna Medicare Advantage	$219.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.33
Rate for Payer: Cigna Commercial	$365.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.21
Rate for Payer: Oxford Commercial	$146.14
Rate for Payer: Qualcare PPO/HMO/WC	$109.61
Rate for Payer: UnitedHealthcare Commercial	$146.14
Rate for Payer: UnitedHealthcare Community & State	$17.61
Rate for Payer: Wellpoint Medicaid Managed Care	$19.36

MYCOPHENOLATE CAP 250MG

Facility

$57.42

Service Code	HCPCS J7517
Hospital Charge Code	60628535
Hospital Revenue Code	636
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$13.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.61

MYCOPHENOLATE CAP 250MG

Facility

$57.42

Service Code	HCPCS J7517
Hospital Charge Code	60628535
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$28.71
Rate for Payer: Aetna Commercial	$21.82
Rate for Payer: Aetna Medicare Advantage	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.64
Rate for Payer: Cigna Commercial	$28.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.61
Rate for Payer: UnitedHealthcare Community & State	$1.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

MYCOPHENOLATE CAP 250MG

Facility

$12.80

Hospital Charge Code	60628663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

MYCOPHENOLATE CAP 250MG

Facility

$12.80

Hospital Charge Code	60628663
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.84
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$7.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.03
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.03
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$13.40
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

MYCOPLASMA IGG/IGM SCREEN

Facility

$108.00

Service Code	HCPCS 86318
Hospital Charge Code	3001021
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$58.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.30
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: Cigna Medicare Advantage	$18.09
Rate for Payer: Clover Medicare Advantage	$17.19
Rate for Payer: EmblemHealth Commercial	$54.27
Rate for Payer: Humana Medicare Advantage	$18.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.09
Rate for Payer: Wellcare Medicare Advantage	$18.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

MYCOPLASMA IGG/IGM SCREEN

Facility

$108.00

Service Code	HCPCS 86318
Hospital Charge Code	3001021
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

MYCOPLASMA PNEUMONIAE AB IGG

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

MYCOPLASMA PNEUMONIAE AB IGG

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
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	$64.00
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	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
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	$3.39

MYCOPLASMA PNEUMONIAE AB IGM

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
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	$64.00
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	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
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	$3.39

MYCOPLASMA PNEUMONIAE AB IGM

Facility

$128.00

Service Code	HCPCS 86738
Hospital Charge Code	3004785A
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

MYCOPLASMA PNEUMONIAE CULTURE

Facility

$256.00

Service Code	HCPCS 87109
Hospital Charge Code	3009370
Hospital Revenue Code	309
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.55
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.78

MYCOPLASMA PNEUMONIAE CULTURE

Facility

$256.00

Service Code	HCPCS 87109
Hospital Charge Code	3009370
Hospital Revenue Code	309
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

MYCOSTATIN/15GM

Facility

$104.00

Hospital Charge Code	60633475
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

MYCOSTATIN/15GM

Facility

$104.00

Hospital Charge Code	60633475
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$39.52
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$20.80
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.85
Rate for Payer: Oxford Commercial	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.90
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

Know your out-of-pocket cost for care.

All Charges