Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

END TIDAL CO2

Facility

$2,476.94

Service Code	HCPCS 94770
Hospital Charge Code	411094770
Hospital Revenue Code	460
Min. Negotiated Rate	$59.69
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$941.24
Rate for Payer: Aetna Medicare Advantage	$743.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.62
Rate for Payer: Cigna Commercial	$1,238.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.08
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.54
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$59.69
Rate for Payer: Wellpoint Medicaid Managed Care	$65.64

END TIDAL CO2

Facility

$10,357.02

Service Code	HCPCS 94770
Hospital Charge Code	9501295
Hospital Revenue Code	460
Min. Negotiated Rate	$1,553.55
Max. Negotiated Rate	$1,553.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,553.55

END TIDAL CO2

Facility

$10,357.02

Service Code	HCPCS 94770
Hospital Charge Code	9501295
Hospital Revenue Code	460
Min. Negotiated Rate	$249.60
Max. Negotiated Rate	$5,178.51
Rate for Payer: Aetna Commercial	$3,935.67
Rate for Payer: Aetna Medicare Advantage	$3,107.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,641.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,641.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,641.04
Rate for Payer: Cigna Commercial	$5,178.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,107.11
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,553.55
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$249.60
Rate for Payer: Wellpoint Medicaid Managed Care	$274.46

END TIDAL CO2

Facility

$2,476.94

Service Code	HCPCS 94770
Hospital Charge Code	411094770
Hospital Revenue Code	460
Min. Negotiated Rate	$371.54
Max. Negotiated Rate	$371.54
Rate for Payer: Qualcare PPO/HMO/WC	$371.54

ENDURONYL/TAB

Facility

$3.00

Hospital Charge Code	60634222
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ENDURONYL/TAB

Facility

$3.00

Hospital Charge Code	60634222
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ENEMA SET DISP

Facility

$7.18

Hospital Charge Code	270649734
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

ENEMA SET DISP

Facility

$7.18

Hospital Charge Code	270649734
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.59
Rate for Payer: Aetna Commercial	$2.73
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.44
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

ENFAMIL

Facility

$34.60

Hospital Charge Code	6008239
Hospital Revenue Code	252
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ENFAMIL

Facility

$34.60

Hospital Charge Code	6008239
Hospital Revenue Code	252
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

ENFAMIL INFANT FORMUL LOW IRON

Facility

$104.00

Hospital Charge Code	60628776
Hospital Revenue Code	270
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

ENFAMIL INFANT FORMUL LOW IRON

Facility

$104.00

Hospital Charge Code	60628776
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

ENFLURANE 100% GAS

Facility

$1,276.85

Hospital Charge Code	60627667
Hospital Revenue Code	250
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$485.20
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.06
Rate for Payer: Oxford Commercial	$255.37
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$255.37
Rate for Payer: UnitedHealthcare Community & State	$30.77
Rate for Payer: Wellpoint Medicaid Managed Care	$33.84

ENFLURANE 100% GAS

Facility

$1,276.85

Hospital Charge Code	60627667
Hospital Revenue Code	250
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ENFLURANE INH 125ML

Facility

$985.60

Hospital Charge Code	6002166
Hospital Revenue Code	251
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$492.80
Rate for Payer: Aetna Commercial	$374.53
Rate for Payer: Aetna Medicare Advantage	$295.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.33
Rate for Payer: Cigna Commercial	$492.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.68
Rate for Payer: Oxford Commercial	$197.12
Rate for Payer: Qualcare PPO/HMO/WC	$147.84
Rate for Payer: UnitedHealthcare Commercial	$197.12
Rate for Payer: UnitedHealthcare Community & State	$23.75
Rate for Payer: Wellpoint Medicaid Managed Care	$26.12

ENFLURANE INH 125ML

Facility

$985.60

Hospital Charge Code	6002166
Hospital Revenue Code	251
Min. Negotiated Rate	$147.84
Max. Negotiated Rate	$147.84
Rate for Payer: Qualcare PPO/HMO/WC	$147.84

ENGERIX-B PEDIATRIC

Facility

$162.00

Service Code	HCPCS 90743
Hospital Charge Code	60634776
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$39.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

ENGERIX-B PEDIATRIC

Facility

$162.00

Service Code	HCPCS 90743
Hospital Charge Code	60634776
Hospital Revenue Code	636
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

ENHANCE COUNSELING WHC*****

Facility

$60.00

Service Code	HCPCS Y7633WF
Hospital Charge Code	9600013
Hospital Revenue Code	519
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

ENHANCE COUNSELING WHC*****

Facility

$60.00

Service Code	HCPCS Y7633WF
Hospital Charge Code	9600013
Hospital Revenue Code	519
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

ENHANCED LIVER FIBROSIS (ELF)

Facility

$340.00

Service Code	HCPCS 81517
Hospital Charge Code	397080022
Hospital Revenue Code	310
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$635.99
Rate for Payer: Aetna Commercial	$479.24
Rate for Payer: Aetna Medicare Advantage	$570.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$176.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.99
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: Cigna Medicare Advantage	$176.19
Rate for Payer: Clover Medicare Advantage	$167.38
Rate for Payer: EmblemHealth Commercial	$528.57
Rate for Payer: Humana Medicare Advantage	$181.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$176.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.19
Rate for Payer: Wellcare Medicare Advantage	$176.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

ENHANCED LIVER FIBROSIS (ELF)

Facility

$340.00

Service Code	HCPCS 81517
Hospital Charge Code	397080022
Hospital Revenue Code	310
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

ENISYL/500MG/TAB

Facility

$4.00

Service Code	NDC 536673101
Hospital Charge Code	60632936
Hospital Revenue Code	250
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

ENISYL/500MG/TAB

Facility

$4.00

Service Code	NDC 536673101
Hospital Charge Code	60632936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ENOXAPARIN 100 MG SYRINGE

Facility

$605.08

Service Code	HCPCS J1650
Hospital Charge Code	60628902
Hospital Revenue Code	636
Min. Negotiated Rate	$14.58
Max. Negotiated Rate	$302.54
Rate for Payer: Aetna Commercial	$229.93
Rate for Payer: Aetna Medicare Advantage	$181.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.30
Rate for Payer: Cigna Commercial	$302.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.76
Rate for Payer: UnitedHealthcare Community & State	$14.58
Rate for Payer: Wellpoint Medicaid Managed Care	$16.03

Know your out-of-pocket cost for care.

All Charges