Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE OPH SOL 0.5% 7.5ML

Facility

$64.00

Hospital Charge Code	6002208
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

EPINEPHRINE OPH SOL 0.5% 7.5ML

Facility

$64.00

Hospital Charge Code	6002208
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

EPINEPHRINE OPH SOL 1%

Facility

$156.20

Hospital Charge Code	60628070
Hospital Revenue Code	250
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$23.43
Rate for Payer: Qualcare PPO/HMO/WC	$23.43

EPINEPHRINE OPH SOL 1%

Facility

$156.20

Hospital Charge Code	60628070
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$78.10
Rate for Payer: Aetna Commercial	$59.36
Rate for Payer: Aetna Medicare Advantage	$46.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.83
Rate for Payer: Cigna Commercial	$78.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.86
Rate for Payer: Oxford Commercial	$31.24
Rate for Payer: Qualcare PPO/HMO/WC	$23.43
Rate for Payer: UnitedHealthcare Commercial	$31.24
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.14

EPINEPHRINE OPH SOL 1% 15ML

Facility

$64.00

Hospital Charge Code	6002216
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

EPINEPHRINE OPH SOL 1% 15ML

Facility

$64.00

Hospital Charge Code	6002216
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

EPINEPHRINE OPH SOL 2%

Facility

$172.20

Hospital Charge Code	60628072
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.10
Rate for Payer: Aetna Commercial	$65.44
Rate for Payer: Aetna Medicare Advantage	$51.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.91
Rate for Payer: Cigna Commercial	$86.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.66
Rate for Payer: Oxford Commercial	$34.44
Rate for Payer: Qualcare PPO/HMO/WC	$25.83
Rate for Payer: UnitedHealthcare Commercial	$34.44
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

EPINEPHRINE OPH SOL 2%

Facility

$172.20

Hospital Charge Code	60628072
Hospital Revenue Code	250
Min. Negotiated Rate	$25.83
Max. Negotiated Rate	$25.83
Rate for Payer: Qualcare PPO/HMO/WC	$25.83

EPINEPHRINE OPH SOL 2% 15ML

Facility

$64.00

Hospital Charge Code	6002224
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

EPINEPHRINE OPH SOL 2% 15ML

Facility

$64.00

Hospital Charge Code	6002224
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

EPINEPHRINE SSP 1:200 0.3ML

Facility

$26.90

Hospital Charge Code	6012496
Hospital Revenue Code	294
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

EPINEPHRINE SSP 1:200 0.3ML

Facility

$26.90

Hospital Charge Code	6012496
Hospital Revenue Code	294
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

EPINEPHRINE TOP SOL 1:1000

Facility

$62.10

Hospital Charge Code	6012504
Hospital Revenue Code	251
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

EPINEPHRINE TOP SOL 1:1000

Facility

$62.10

Hospital Charge Code	6012504
Hospital Revenue Code	251
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

EPIPEN 0.15MG/0.15ML INJ

Facility

$1,654.97

Service Code	NDC 115169549
Hospital Charge Code	6063943104
Hospital Revenue Code	250
Min. Negotiated Rate	$39.88
Max. Negotiated Rate	$827.49
Rate for Payer: Aetna Commercial	$628.89
Rate for Payer: Aetna Medicare Advantage	$496.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.02
Rate for Payer: Cigna Commercial	$827.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.49
Rate for Payer: Oxford Commercial	$330.99
Rate for Payer: Qualcare PPO/HMO/WC	$248.25
Rate for Payer: UnitedHealthcare Commercial	$330.99
Rate for Payer: UnitedHealthcare Community & State	$39.88
Rate for Payer: Wellpoint Medicaid Managed Care	$43.86

EPIPEN 0.15MG/0.15ML INJ

Facility

$1,654.97

Service Code	NDC 115169549
Hospital Charge Code	6063943104
Hospital Revenue Code	250
Min. Negotiated Rate	$248.25
Max. Negotiated Rate	$248.25
Rate for Payer: Qualcare PPO/HMO/WC	$248.25

EPIPEN 0.3MG/ML INJ

Facility

$1,612.89

Service Code	NDC 49502050002
Hospital Charge Code	6063943105
Hospital Revenue Code	250
Min. Negotiated Rate	$241.93
Max. Negotiated Rate	$241.93
Rate for Payer: Qualcare PPO/HMO/WC	$241.93

EPIPEN 0.3MG/ML INJ

Facility

$1,612.89

Service Code	NDC 49502050002
Hospital Charge Code	6063943105
Hospital Revenue Code	250
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$806.45
Rate for Payer: Aetna Commercial	$612.90
Rate for Payer: Aetna Medicare Advantage	$483.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.29
Rate for Payer: Cigna Commercial	$806.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.87
Rate for Payer: Oxford Commercial	$322.58
Rate for Payer: Qualcare PPO/HMO/WC	$241.93
Rate for Payer: UnitedHealthcare Commercial	$322.58
Rate for Payer: UnitedHealthcare Community & State	$38.87
Rate for Payer: Wellpoint Medicaid Managed Care	$42.74

Epirubicin 200mg/100ml

Facility

$1,344.00

Hospital Charge Code	6000438
Hospital Revenue Code	636
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$325.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

Epirubicin 200mg/100ml

Facility

$1,344.00

Hospital Charge Code	6000438
Hospital Revenue Code	636
Min. Negotiated Rate	$32.39
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$510.72
Rate for Payer: Aetna Medicare Advantage	$403.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.72
Rate for Payer: Cigna Commercial	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$35.62

EPIRUBICIN 50 MG/25ML INJ

Facility

$3,680.85

Hospital Charge Code	60629234
Hospital Revenue Code	636
Min. Negotiated Rate	$88.71
Max. Negotiated Rate	$1,840.42
Rate for Payer: Aetna Commercial	$1,398.72
Rate for Payer: Aetna Medicare Advantage	$1,104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$938.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$938.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$938.62
Rate for Payer: Cigna Commercial	$1,840.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.77
Rate for Payer: Qualcare PPO/HMO/WC	$552.13
Rate for Payer: UnitedHealthcare Community & State	$88.71
Rate for Payer: Wellpoint Medicaid Managed Care	$97.54

EPIRUBICIN 50 MG/25ML INJ

Facility

$3,680.85

Hospital Charge Code	60629234
Hospital Revenue Code	636
Min. Negotiated Rate	$552.13
Max. Negotiated Rate	$890.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.77
Rate for Payer: Qualcare PPO/HMO/WC	$552.13

Epirubicin 50mg vial

Facility

$231.25

Hospital Charge Code	6000437
Hospital Revenue Code	636
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$115.62
Rate for Payer: Aetna Commercial	$87.88
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.96
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

Epirubicin 50mg vial

Facility

$231.25

Hospital Charge Code	6000437
Hospital Revenue Code	636
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$55.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.96
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

EPISTAXIS WITH MCC

Facility

$45,170.39

Service Code	MSDRG 150
Min. Negotiated Rate	$13,753.81
Max. Negotiated Rate	$45,170.39
Rate for Payer: Aetna Commercial	$31,294.52
Rate for Payer: Aetna Medicare Advantage	$45,170.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,471.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,471.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,477.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,471.91
Rate for Payer: Cigna Commercial	$24,917.69
Rate for Payer: Cigna Medicare Advantage	$14,477.69
Rate for Payer: Clover Medicare Advantage	$13,753.81
Rate for Payer: EmblemHealth Commercial	$43,433.07
Rate for Payer: Humana Medicare Advantage	$14,912.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,477.69
Rate for Payer: Oxford Commercial	$17,908.67
Rate for Payer: UnitedHealthcare Commercial	$31,403.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,477.69
Rate for Payer: Wellcare Medicare Advantage	$14,477.69

Know your out-of-pocket cost for care.

All Charges