Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$20.18

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$51.59
Rate for Payer: Qualcare PPO/HMO/WC	$51.59

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$171.96
Rate for Payer: Aetna Commercial	$130.69
Rate for Payer: Aetna Medicare Advantage	$103.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.70
Rate for Payer: Cigna Commercial	$171.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.17
Rate for Payer: Oxford Commercial	$68.78
Rate for Payer: Qualcare PPO/HMO/WC	$51.59
Rate for Payer: UnitedHealthcare Commercial	$68.78
Rate for Payer: UnitedHealthcare Community & State	$8.29
Rate for Payer: Wellpoint Medicaid Managed Care	$9.11

EMTRIVA ORAL SOLN 10MG/ML

Facility

$5.63

Service Code	NDC 61958060201
Hospital Charge Code	60635533
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

EMTRIVA ORAL SOLN 10MG/ML

Facility

$5.63

Service Code	NDC 61958060201
Hospital Charge Code	60635533
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

ENA AB (SM/RNP)

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990026EX
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
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	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ENA AB (SM/RNP)

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990026EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ENA AB (SM/RNP) I

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.84
Rate for Payer: Aetna Medicare Advantage	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.43
Rate for Payer: Cigna Commercial	$61.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

ENA AB (SM/RNP) I

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026A
Hospital Revenue Code	306
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$18.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.49

ENA AB (SM/RNP) II

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026B
Hospital Revenue Code	306
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$18.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.49

ENA AB (SM/RNP) II

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.84
Rate for Payer: Aetna Medicare Advantage	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.43
Rate for Payer: Cigna Commercial	$61.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

ENALAPRIL 10 MG TAB

Facility

$10.45

Hospital Charge Code	6024178
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

ENALAPRIL 10 MG TAB

Facility

$10.45

Hospital Charge Code	6024178
Hospital Revenue Code	251
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

ENALAPRIL 10MG TABLET

Facility

$8.71

Service Code	NDC 68084039101
Hospital Charge Code	60632216
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

ENALAPRIL 10MG TABLET

Facility

$8.71

Service Code	NDC 68084039101
Hospital Charge Code	60632216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.61
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

ENALAPRIL 1.25 MG/ML INJ

Facility

$13.74

Service Code	NDC 409212201
Hospital Charge Code	6009443
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

ENALAPRIL 1.25 MG/ML INJ

Facility

$13.74

Service Code	NDC 409212201
Hospital Charge Code	6009443
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$5.22
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.12
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

ENALAPRIL 2.5MG 2ML INJ

Facility

$23.25

Service Code	NDC 409212202
Hospital Charge Code	6063943103
Hospital Revenue Code	250
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.49

ENALAPRIL 2.5MG 2ML INJ

Facility

$23.25

Service Code	NDC 409212202
Hospital Charge Code	6063943103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.62
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare Advantage	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.93
Rate for Payer: Cigna Commercial	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.49
Rate for Payer: UnitedHealthcare Commercial	$4.65
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

ENALAPRIL 2.5 MG/ML INJ

Facility

$18.00

Hospital Charge Code	6009450
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

ENALAPRIL 2.5 MG/ML INJ

Facility

$18.00

Hospital Charge Code	6009450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

ENALAPRIL 2.5 MG TAB

Facility

$4.00

Hospital Charge Code	60629827
Hospital Revenue Code	251
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

ENALAPRIL 2.5 MG TAB

Facility

$4.00

Hospital Charge Code	60629827
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ENALAPRIL 2.5MG TABLET

Facility

$9.78

Service Code	NDC 904560961
Hospital Charge Code	60632217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$1.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$1.96
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

ENALAPRIL 2.5MG TABLET

Facility

$9.78

Service Code	NDC 904560961
Hospital Charge Code	60632217
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

Know your out-of-pocket cost for care.

All Charges