Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EFFEXOR/37.5MG

Facility

$5.00

Hospital Charge Code	60634991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

EFFEXOR/37.5MG

Facility

$5.00

Hospital Charge Code	60634991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

EFFEXOR/50MG

Facility

$6.00

Hospital Charge Code	60634993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

EFFEXOR/50MG

Facility

$6.00

Hospital Charge Code	60634993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

EFFEXOR/75MG

Facility

$5.00

Hospital Charge Code	60634994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

EFFEXOR/75MG

Facility

$5.00

Hospital Charge Code	60634994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

EFFEXOR XR 150MG U/D

Facility

$71.76

Service Code	NDC 8083603
Hospital Charge Code	60635227
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$35.88
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$21.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.30
Rate for Payer: Cigna Commercial	$35.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.53
Rate for Payer: Oxford Commercial	$14.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.76
Rate for Payer: UnitedHealthcare Commercial	$14.35
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

EFFEXOR XR 150MG U/D

Facility

$71.76

Service Code	NDC 8083603
Hospital Charge Code	60635227
Hospital Revenue Code	250
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$10.76

EFFEXOR XR 75MG U/D

Facility

$7.00

Hospital Charge Code	60635226
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

EFFEXOR XR 75MG U/D

Facility

$7.00

Hospital Charge Code	60635226
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

EFFIENT 10 MG TABLET

Facility

$32.70

Hospital Charge Code	60630036
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Qualcare PPO/HMO/WC	$4.91

EFFIENT 10 MG TABLET

Facility

$32.70

Hospital Charge Code	60630036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.35
Rate for Payer: Aetna Commercial	$12.43
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.34
Rate for Payer: Cigna Commercial	$16.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.81
Rate for Payer: Oxford Commercial	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.91
Rate for Payer: UnitedHealthcare Commercial	$6.54
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

EFODINE/30GM

Facility

$1.00

Hospital Charge Code	60632926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

EFODINE/30GM

Facility

$1.00

Hospital Charge Code	60632926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

EFUDEX 5%/25GM

Facility

$167.00

Hospital Charge Code	60632927
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

EFUDEX 5%/25GM

Facility

$167.00

Hospital Charge Code	60632927
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$33.40
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

EGD CONTROL BLEEDING ANY

Facility

$12,832.50

Service Code	HCPCS 43255
Hospital Charge Code	16000963
Hospital Revenue Code	360
Min. Negotiated Rate	$1,924.88
Max. Negotiated Rate	$1,924.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.88

EGD CONTROL BLEEDING ANY

Facility

$12,832.50

Service Code	HCPCS 43255
Hospital Charge Code	16000963
Hospital Revenue Code	360
Min. Negotiated Rate	$309.26
Max. Negotiated Rate	$8,229.07
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,229.07
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,849.75
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.88
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$309.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellpoint Medicaid Managed Care	$340.06

EGD - EMERGENCY***

Facility

$527.00

Hospital Charge Code	2300481
Hospital Revenue Code	361
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$79.05
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

EGD - EMERGENCY***

Facility

$527.00

Hospital Charge Code	2300481
Hospital Revenue Code	361
Min. Negotiated Rate	$12.70
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$200.26
Rate for Payer: Aetna Medicare Advantage	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.38
Rate for Payer: Cigna Commercial	$263.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.10
Rate for Payer: Qualcare PPO/HMO/WC	$79.05
Rate for Payer: UnitedHealthcare Community & State	$12.70
Rate for Payer: Wellpoint Medicaid Managed Care	$13.97

EGD-OSCOPY W/ATTEMPTED PEG***

Facility

$340.00

Service Code	HCPCS 99999
Hospital Charge Code	2300291
Hospital Revenue Code	759
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

EGD-OSCOPY W/ATTEMPTED PEG***

Facility

$340.00

Service Code	HCPCS 99999
Hospital Charge Code	2300291
Hospital Revenue Code	759
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

EGDOSCOPY W/BALLN DILATATION**

Facility

$356.00

Hospital Charge Code	2300192
Hospital Revenue Code	759
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$178.00
Rate for Payer: Aetna Commercial	$135.28
Rate for Payer: Aetna Medicare Advantage	$106.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.78
Rate for Payer: Cigna Commercial	$178.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.80
Rate for Payer: Qualcare PPO/HMO/WC	$53.40
Rate for Payer: UnitedHealthcare Community & State	$8.58
Rate for Payer: Wellpoint Medicaid Managed Care	$9.43

EGDOSCOPY W/BALLN DILATATION**

Facility

$356.00

Hospital Charge Code	2300192
Hospital Revenue Code	759
Min. Negotiated Rate	$53.40
Max. Negotiated Rate	$53.40
Rate for Payer: Qualcare PPO/HMO/WC	$53.40

EGD-OSCOPY W/BICAP CAUT***

Facility

$351.00

Hospital Charge Code	2300119
Hospital Revenue Code	759
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$133.38
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Qualcare PPO/HMO/WC	$52.65
Rate for Payer: UnitedHealthcare Community & State	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$9.30

Know your out-of-pocket cost for care.

All Charges