Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MYCOSTATIN VAGINAL/100KU

Facility

$7.00

Hospital Charge Code	60633477
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

MYCOSTATIN VAGINAL/100KU

Facility

$7.00

Hospital Charge Code	60633477
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MYDRIACYL EYE DROPS 2ML

Facility

$26.00

Hospital Charge Code	60635252
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

MYDRIACYL EYE DROPS 2ML

Facility

$26.00

Hospital Charge Code	60635252
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

MYDRIAFAIR 0.5%/15ML

Facility

$28.00

Hospital Charge Code	60634564
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

MYDRIAFAIR 0.5%/15ML

Facility

$28.00

Hospital Charge Code	60634564
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

MYDRIAFAIR 0.5% OPTH 15ML

Facility

$112.00

Hospital Charge Code	60635239
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$42.56
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$22.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$22.40
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

MYDRIAFAIR 0.5% OPTH 15ML

Facility

$112.00

Hospital Charge Code	60635239
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

MYELIN BASIC PROTEIN

Facility

$390.00

Service Code	HCPCS 83873
Hospital Charge Code	39900109
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.09
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
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	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYELIN BASIC PROTEIN

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3009768
Hospital Revenue Code	301
Min. Negotiated Rate	$38.65
Max. Negotiated Rate	$38.65
Rate for Payer: Qualcare PPO/HMO/WC	$38.65

MYELIN BASIC PROTEIN

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3009768
Hospital Revenue Code	301
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$128.82
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.09
Rate for Payer: Cigna Commercial	$128.82
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$6.83

MYELIN BASIC PROTEIN

Facility

$390.00

Service Code	HCPCS 83873
Hospital Charge Code	39900109
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYELIN BASIC PROTEIN,CSF

Facility

$291.00

Service Code	HCPCS 83873
Hospital Charge Code	38472749
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

MYELIN BASIC PROTEIN,CSF

Facility

$291.00

Service Code	HCPCS 83873
Hospital Charge Code	38472749
Hospital Revenue Code	301
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.09
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

MYELIN CSF

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3035112
Hospital Revenue Code	301
Min. Negotiated Rate	$38.65
Max. Negotiated Rate	$38.65
Rate for Payer: Qualcare PPO/HMO/WC	$38.65

MYELIN CSF

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3035112
Hospital Revenue Code	301
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$128.82
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.09
Rate for Payer: Cigna Commercial	$128.82
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$6.83

MYELIN GLYCOPROTEIN DUAL#T95**

Facility

$214.00

Hospital Charge Code	3010683
Hospital Revenue Code	301
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

MYELIN GLYCOPROTEIN DUAL#T95**

Facility

$214.00

Hospital Charge Code	3010683
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

MYELOGRAM INJ; SPINAL NOT C1-C

Facility

$2,994.91

Service Code	HCPCS 62284
Hospital Charge Code	16001016
Hospital Revenue Code	360
Min. Negotiated Rate	$72.18
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,138.07
Rate for Payer: Aetna Medicare Advantage	$898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$763.70
Rate for Payer: Cigna Commercial	$1,497.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$898.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$72.18

MYELOGRAM INJ; SPINAL NOT C1-C

Facility

$2,994.91

Service Code	HCPCS 62284
Hospital Charge Code	16001016
Hospital Revenue Code	360
Min. Negotiated Rate	$449.24
Max. Negotiated Rate	$449.24
Rate for Payer: Qualcare PPO/HMO/WC	$449.24

MYELOPEROXIDASE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	39900188
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYELOPEROXIDASE AB

Facility

$205.65

Service Code	HCPCS 86021
Hospital Charge Code	3035150
Hospital Revenue Code	302
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

MYELOPEROXIDASE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	39900188
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
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	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYELOPEROXIDASE AB

Facility

$205.65

Service Code	HCPCS 86021
Hospital Charge Code	3035150
Hospital Revenue Code	302
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

MYELOPEROXIDASE (MPO)

Facility

$240.40

Service Code	HCPCS 83876
Hospital Charge Code	38477190
Hospital Revenue Code	301
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$36.06
Rate for Payer: Qualcare PPO/HMO/WC	$36.06

Know your out-of-pocket cost for care.

All Charges