Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE 0.5% OPHTH SOLN

Facility

$319.25

Hospital Charge Code	60628069
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$159.62
Rate for Payer: Aetna Commercial	$121.31
Rate for Payer: Aetna Medicare Advantage	$95.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.41
Rate for Payer: Cigna Commercial	$159.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.78
Rate for Payer: Oxford Commercial	$63.85
Rate for Payer: Qualcare PPO/HMO/WC	$47.89
Rate for Payer: UnitedHealthcare Commercial	$63.85
Rate for Payer: UnitedHealthcare Community & State	$7.69
Rate for Payer: Wellpoint Medicaid Managed Care	$8.46

EPINEPHRINE 1:10000/0.1MG

Facility

$36.00

Hospital Charge Code	60632940
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

EPINEPHRINE 1:10000/0.1MG

Facility

$36.00

Hospital Charge Code	60632940
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

EPINEPHRINE 1 1000 NASAL SOL

Facility

$718.64

Service Code	NDC 42023010301
Hospital Charge Code	60627451
Hospital Revenue Code	250
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$359.32
Rate for Payer: Aetna Commercial	$273.08
Rate for Payer: Aetna Medicare Advantage	$215.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.25
Rate for Payer: Cigna Commercial	$359.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.59
Rate for Payer: Oxford Commercial	$143.73
Rate for Payer: Qualcare PPO/HMO/WC	$107.80
Rate for Payer: UnitedHealthcare Commercial	$143.73
Rate for Payer: UnitedHealthcare Community & State	$17.32
Rate for Payer: Wellpoint Medicaid Managed Care	$19.04

EPINEPHRINE 1 1000 NASAL SOL

Facility

$718.64

Service Code	NDC 42023010301
Hospital Charge Code	60627451
Hospital Revenue Code	250
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$107.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.80

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Commercial	$5.93
Rate for Payer: Aetna Medicare Advantage	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.98
Rate for Payer: Cigna Commercial	$7.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.48
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

EPINEPHRINE 1% OPHTH SOLN

Facility

$341.65

Hospital Charge Code	60628071
Hospital Revenue Code	250
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$51.25
Rate for Payer: Qualcare PPO/HMO/WC	$51.25

EPINEPHRINE 1% OPHTH SOLN

Facility

$341.65

Hospital Charge Code	60628071
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$170.82
Rate for Payer: Aetna Commercial	$129.83
Rate for Payer: Aetna Medicare Advantage	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.12
Rate for Payer: Cigna Commercial	$170.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.50
Rate for Payer: Oxford Commercial	$68.33
Rate for Payer: Qualcare PPO/HMO/WC	$51.25
Rate for Payer: UnitedHealthcare Commercial	$68.33
Rate for Payer: UnitedHealthcare Community & State	$8.23
Rate for Payer: Wellpoint Medicaid Managed Care	$9.05

EPINEPHRINE 2% OPHTH SOLN

Facility

$373.65

Hospital Charge Code	60628073
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$186.82
Rate for Payer: Aetna Commercial	$141.99
Rate for Payer: Aetna Medicare Advantage	$112.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.28
Rate for Payer: Cigna Commercial	$186.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.09
Rate for Payer: Oxford Commercial	$74.73
Rate for Payer: Qualcare PPO/HMO/WC	$56.05
Rate for Payer: UnitedHealthcare Commercial	$74.73
Rate for Payer: UnitedHealthcare Community & State	$9.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.90

EPINEPHRINE 2% OPHTH SOLN

Facility

$373.65

Hospital Charge Code	60628073
Hospital Revenue Code	250
Min. Negotiated Rate	$56.05
Max. Negotiated Rate	$56.05
Rate for Payer: Qualcare PPO/HMO/WC	$56.05

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.14
Rate for Payer: Aetna Commercial	$21.39
Rate for Payer: Aetna Medicare Advantage	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.35
Rate for Payer: Cigna Commercial	$28.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

EPINEPHRINE AMP 1MG/ML

Facility

$10.90

Hospital Charge Code	6008783
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

EPINEPHRINE AMP 1MG/ML

Facility

$10.90

Hospital Charge Code	6008783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

EPINEPHRINE INJ 1:200

Facility

$10.90

Hospital Charge Code	60627449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

EPINEPHRINE INJ 1:200

Facility

$10.90

Hospital Charge Code	60627449
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

EPINEPHRINE INJ 5MG/ML 0.5ML

Facility

$131.85

Hospital Charge Code	6002182
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.55
Rate for Payer: Oxford Commercial	$26.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$26.37
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

EPINEPHRINE INJ 5MG/ML 0.5ML

Facility

$131.85

Hospital Charge Code	6002182
Hospital Revenue Code	250
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna Medicare Advantage	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.61
Rate for Payer: Cigna Commercial	$7.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.24
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.12
Rate for Payer: UnitedHealthcare Commercial	$2.83
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.12

EPINEPHRINE NSL SOL 0.1%

Facility

$117.00

Service Code	HCPCS J7640
Hospital Charge Code	6002190
Hospital Revenue Code	294
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

EPINEPHRINE NSL SOL 0.1%

Facility

$117.00

Service Code	HCPCS J7640
Hospital Charge Code	6002190
Hospital Revenue Code	294
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

Know your out-of-pocket cost for care.

All Charges