Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPISTAXIS WITHOUT MCC

Facility

$25,858.15

Service Code	MSDRG 151
Min. Negotiated Rate	$7,873.48
Max. Negotiated Rate	$25,858.15
Rate for Payer: Aetna Commercial	$18,024.83
Rate for Payer: Aetna Medicare Advantage	$25,858.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,910.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,910.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,287.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,910.97
Rate for Payer: Cigna Commercial	$13,736.08
Rate for Payer: Cigna Medicare Advantage	$8,287.87
Rate for Payer: Clover Medicare Advantage	$7,873.48
Rate for Payer: EmblemHealth Commercial	$24,863.61
Rate for Payer: Humana Medicare Advantage	$8,536.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,287.87
Rate for Payer: Oxford Commercial	$9,872.30
Rate for Payer: UnitedHealthcare Commercial	$17,311.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,287.87
Rate for Payer: Wellcare Medicare Advantage	$8,287.87

EPIVIR 150MG TAB

Facility

$24.00

Hospital Charge Code	60635066
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

EPIVIR 150MG TAB

Facility

$24.00

Hospital Charge Code	60635066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

EPIVIR ORAL SOL 10MG/ML

Facility

$276.00

Hospital Charge Code	60635174
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

EPIVIR ORAL SOL 10MG/ML

Facility

$276.00

Hospital Charge Code	60635174
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

EPOETIN ALFA 10,000 UNIT/ML ML

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	60635894
Hospital Revenue Code	635
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$855.05
Rate for Payer: Aetna Commercial	$649.84
Rate for Payer: Aetna Medicare Advantage	$513.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.08
Rate for Payer: Cigna Commercial	$855.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.03
Rate for Payer: Oxford Commercial	$342.02
Rate for Payer: Qualcare PPO/HMO/WC	$256.52
Rate for Payer: UnitedHealthcare Commercial	$342.02
Rate for Payer: UnitedHealthcare Community & State	$41.21
Rate for Payer: Wellpoint Medicaid Managed Care	$45.32

EPOETIN ALFA 10,000 UNIT/ML ML

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	60635894
Hospital Revenue Code	635
Min. Negotiated Rate	$256.52
Max. Negotiated Rate	$256.52
Rate for Payer: Qualcare PPO/HMO/WC	$256.52

EPOETIN ALFA 10,000 UNITS/1MLE

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	606361051
Hospital Revenue Code	635
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$855.05
Rate for Payer: Aetna Commercial	$649.84
Rate for Payer: Aetna Medicare Advantage	$513.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.08
Rate for Payer: Cigna Commercial	$855.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.03
Rate for Payer: Oxford Commercial	$342.02
Rate for Payer: Qualcare PPO/HMO/WC	$256.52
Rate for Payer: UnitedHealthcare Commercial	$342.02
Rate for Payer: UnitedHealthcare Community & State	$41.21
Rate for Payer: Wellpoint Medicaid Managed Care	$45.32

EPOETIN ALFA 10,000 UNITS/1MLE

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	606361051
Hospital Revenue Code	635
Min. Negotiated Rate	$256.52
Max. Negotiated Rate	$256.52
Rate for Payer: Qualcare PPO/HMO/WC	$256.52

EPOETIN ALFA 20000 UNIT/ML INJ

Facility

$3,420.22

Service Code	NDC 59676032004
Hospital Charge Code	60632231
Hospital Revenue Code	634
Min. Negotiated Rate	$513.03
Max. Negotiated Rate	$513.03
Rate for Payer: Qualcare PPO/HMO/WC	$513.03

EPOETIN ALFA 20000 UNIT/ML INJ

Facility

$3,420.22

Service Code	NDC 59676032004
Hospital Charge Code	60632231
Hospital Revenue Code	634
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$1,710.11
Rate for Payer: Aetna Commercial	$1,299.68
Rate for Payer: Aetna Medicare Advantage	$1,026.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.16
Rate for Payer: Cigna Commercial	$1,710.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.07
Rate for Payer: Oxford Commercial	$684.04
Rate for Payer: Qualcare PPO/HMO/WC	$513.03
Rate for Payer: UnitedHealthcare Commercial	$684.04
Rate for Payer: UnitedHealthcare Community & State	$82.43
Rate for Payer: Wellpoint Medicaid Managed Care	$90.64

EPOETIN ALFA 2000 U/ML INJ

Facility

$310.81

Service Code	NDC 59676030200
Hospital Charge Code	60635891
Hospital Revenue Code	634
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$155.41
Rate for Payer: Aetna Commercial	$118.11
Rate for Payer: Aetna Medicare Advantage	$93.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.26
Rate for Payer: Cigna Commercial	$155.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.24
Rate for Payer: Oxford Commercial	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$46.62
Rate for Payer: UnitedHealthcare Commercial	$62.16
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

EPOETIN ALFA 2000 U/ML INJ

Facility

$310.81

Service Code	NDC 59676030200
Hospital Charge Code	60635891
Hospital Revenue Code	634
Min. Negotiated Rate	$46.62
Max. Negotiated Rate	$46.62
Rate for Payer: Qualcare PPO/HMO/WC	$46.62

EPOETINALFA 3000 U/ML INJ

Facility

$466.25

Service Code	NDC 59676030300
Hospital Charge Code	60635892
Hospital Revenue Code	634
Min. Negotiated Rate	$69.94
Max. Negotiated Rate	$69.94
Rate for Payer: Qualcare PPO/HMO/WC	$69.94

EPOETINALFA 3000 U/ML INJ

Facility

$466.25

Service Code	NDC 59676030300
Hospital Charge Code	60635892
Hospital Revenue Code	634
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$233.12
Rate for Payer: Aetna Commercial	$177.18
Rate for Payer: Aetna Medicare Advantage	$139.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.89
Rate for Payer: Cigna Commercial	$233.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.88
Rate for Payer: Oxford Commercial	$93.25
Rate for Payer: Qualcare PPO/HMO/WC	$69.94
Rate for Payer: UnitedHealthcare Commercial	$93.25
Rate for Payer: UnitedHealthcare Community & State	$11.24
Rate for Payer: Wellpoint Medicaid Managed Care	$12.36

EPOETIN ALFA 40000 UNIT/ML INJ

Facility

$6,840.43

Service Code	NDC 59676034001
Hospital Charge Code	60632230
Hospital Revenue Code	635
Min. Negotiated Rate	$1,026.06
Max. Negotiated Rate	$1,026.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.06

EPOETIN ALFA 40000 UNIT/ML INJ

Facility

$6,840.43

Service Code	NDC 59676034001
Hospital Charge Code	60632230
Hospital Revenue Code	635
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$3,420.22
Rate for Payer: Aetna Commercial	$2,599.36
Rate for Payer: Aetna Medicare Advantage	$2,052.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,744.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,744.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,744.31
Rate for Payer: Cigna Commercial	$3,420.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,052.13
Rate for Payer: Oxford Commercial	$1,368.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.06
Rate for Payer: UnitedHealthcare Commercial	$1,368.09
Rate for Payer: UnitedHealthcare Community & State	$164.85
Rate for Payer: Wellpoint Medicaid Managed Care	$181.27

EPOETINALFA 4000 U/ML ML

Facility

$621.63

Service Code	NDC 59676030401
Hospital Charge Code	60635893
Hospital Revenue Code	634
Min. Negotiated Rate	$93.24
Max. Negotiated Rate	$93.24
Rate for Payer: Qualcare PPO/HMO/WC	$93.24

EPOETINALFA 4000 U/ML ML

Facility

$621.63

Service Code	NDC 59676030401
Hospital Charge Code	60635893
Hospital Revenue Code	634
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$310.81
Rate for Payer: Aetna Commercial	$236.22
Rate for Payer: Aetna Medicare Advantage	$186.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.52
Rate for Payer: Cigna Commercial	$310.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.49
Rate for Payer: Oxford Commercial	$124.33
Rate for Payer: Qualcare PPO/HMO/WC	$93.24
Rate for Payer: UnitedHealthcare Commercial	$124.33
Rate for Payer: UnitedHealthcare Community & State	$14.98
Rate for Payer: Wellpoint Medicaid Managed Care	$16.47

EPOETIN ALFA-EPBX 40000IU VIAL

Facility

$3,048.50

Service Code	NDC 69130904
Hospital Charge Code	606390476
Hospital Revenue Code	635
Min. Negotiated Rate	$73.47
Max. Negotiated Rate	$1,524.25
Rate for Payer: Aetna Commercial	$1,158.43
Rate for Payer: Aetna Medicare Advantage	$914.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.37
Rate for Payer: Cigna Commercial	$1,524.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.55
Rate for Payer: Oxford Commercial	$609.70
Rate for Payer: Qualcare PPO/HMO/WC	$457.27
Rate for Payer: UnitedHealthcare Commercial	$609.70
Rate for Payer: UnitedHealthcare Community & State	$73.47
Rate for Payer: Wellpoint Medicaid Managed Care	$80.79

EPOETIN ALFA-EPBX 40000IU VIAL

Facility

$3,048.50

Service Code	NDC 69130904
Hospital Charge Code	606390476
Hospital Revenue Code	635
Min. Negotiated Rate	$457.27
Max. Negotiated Rate	$457.27
Rate for Payer: Qualcare PPO/HMO/WC	$457.27

EPOETIN ALFAEPFX20000U/ML ESRD

Facility

$1,768.80

Service Code	NDC 69131110
Hospital Charge Code	606390457
Hospital Revenue Code	635
Min. Negotiated Rate	$265.32
Max. Negotiated Rate	$265.32
Rate for Payer: Qualcare PPO/HMO/WC	$265.32

EPOETIN ALFAEPFX20000U/ML ESRD

Facility

$1,768.80

Service Code	NDC 69131110
Hospital Charge Code	606390457
Hospital Revenue Code	635
Min. Negotiated Rate	$42.63
Max. Negotiated Rate	$884.40
Rate for Payer: Aetna Commercial	$672.14
Rate for Payer: Aetna Medicare Advantage	$530.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.04
Rate for Payer: Cigna Commercial	$884.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.64
Rate for Payer: Oxford Commercial	$353.76
Rate for Payer: Qualcare PPO/HMO/WC	$265.32
Rate for Payer: UnitedHealthcare Commercial	$353.76
Rate for Payer: UnitedHealthcare Community & State	$42.63
Rate for Payer: Wellpoint Medicaid Managed Care	$46.87

EPOETIN INJ 10,000U/1ML

Facility

$981.15

Hospital Charge Code	60627530
Hospital Revenue Code	250
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$490.57
Rate for Payer: Aetna Commercial	$372.84
Rate for Payer: Aetna Medicare Advantage	$294.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.19
Rate for Payer: Cigna Commercial	$490.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.35
Rate for Payer: Oxford Commercial	$196.23
Rate for Payer: Qualcare PPO/HMO/WC	$147.17
Rate for Payer: UnitedHealthcare Commercial	$196.23
Rate for Payer: UnitedHealthcare Community & State	$23.65
Rate for Payer: Wellpoint Medicaid Managed Care	$26.00

EPOETIN INJ 10,000U/1ML

Facility

$981.15

Hospital Charge Code	60627530
Hospital Revenue Code	250
Min. Negotiated Rate	$147.17
Max. Negotiated Rate	$147.17
Rate for Payer: Qualcare PPO/HMO/WC	$147.17

Know your out-of-pocket cost for care.

All Charges