Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPOETIN INJ 1,000U/1ML

Facility

$147.85

Service Code	HCPCS J0886
Hospital Charge Code	60628932
Hospital Revenue Code	634
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.35
Rate for Payer: Oxford Commercial	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$29.57
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

EPOETIN INJ 1,000U/1ML

Facility

$147.85

Service Code	HCPCS J0886
Hospital Charge Code	60628932
Hospital Revenue Code	634
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

EPOETIN INJ 1,000U/1ML NONREN

Facility

$147.85

Hospital Charge Code	60629074
Hospital Revenue Code	636
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

EPOETIN INJ 1,000U/1ML NONREN

Facility

$147.85

Hospital Charge Code	60629074
Hospital Revenue Code	636
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$35.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

EPOETIN INJ 11,000U/1ML

Facility

$810.25

Hospital Charge Code	60629063
Hospital Revenue Code	250
Min. Negotiated Rate	$121.54
Max. Negotiated Rate	$121.54
Rate for Payer: Qualcare PPO/HMO/WC	$121.54

EPOETIN INJ 11,000U/1ML

Facility

$810.25

Hospital Charge Code	60629063
Hospital Revenue Code	250
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$405.12
Rate for Payer: Aetna Commercial	$307.89
Rate for Payer: Aetna Medicare Advantage	$243.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.61
Rate for Payer: Cigna Commercial	$405.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.07
Rate for Payer: Oxford Commercial	$162.05
Rate for Payer: Qualcare PPO/HMO/WC	$121.54
Rate for Payer: UnitedHealthcare Commercial	$162.05
Rate for Payer: UnitedHealthcare Community & State	$19.53
Rate for Payer: Wellpoint Medicaid Managed Care	$21.47

EPOETIN INJ 12,000U/1ML

Facility

$883.85

Hospital Charge Code	60629064
Hospital Revenue Code	635
Min. Negotiated Rate	$132.58
Max. Negotiated Rate	$132.58
Rate for Payer: Qualcare PPO/HMO/WC	$132.58

EPOETIN INJ 12,000U/1ML

Facility

$883.85

Hospital Charge Code	60629064
Hospital Revenue Code	635
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$441.93
Rate for Payer: Aetna Commercial	$335.86
Rate for Payer: Aetna Medicare Advantage	$265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.38
Rate for Payer: Cigna Commercial	$441.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.15
Rate for Payer: Oxford Commercial	$176.77
Rate for Payer: Qualcare PPO/HMO/WC	$132.58
Rate for Payer: UnitedHealthcare Commercial	$176.77
Rate for Payer: UnitedHealthcare Community & State	$21.30
Rate for Payer: Wellpoint Medicaid Managed Care	$23.42

EPOETIN INJ 13,000U/1ML

Facility

$957.45

Service Code	HCPCS J0886
Hospital Charge Code	60629065
Hospital Revenue Code	250
Min. Negotiated Rate	$143.62
Max. Negotiated Rate	$143.62
Rate for Payer: Qualcare PPO/HMO/WC	$143.62

EPOETIN INJ 13,000U/1ML

Facility

$957.45

Service Code	HCPCS J0886
Hospital Charge Code	60629065
Hospital Revenue Code	250
Min. Negotiated Rate	$23.07
Max. Negotiated Rate	$478.73
Rate for Payer: Aetna Commercial	$363.83
Rate for Payer: Aetna Medicare Advantage	$287.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.15
Rate for Payer: Cigna Commercial	$478.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.24
Rate for Payer: Oxford Commercial	$191.49
Rate for Payer: Qualcare PPO/HMO/WC	$143.62
Rate for Payer: UnitedHealthcare Commercial	$191.49
Rate for Payer: UnitedHealthcare Community & State	$23.07
Rate for Payer: Wellpoint Medicaid Managed Care	$25.37

EPOETIN INJ 14,000U/1ML

Facility

$1,030.40

Hospital Charge Code	60629066
Hospital Revenue Code	250
Min. Negotiated Rate	$154.56
Max. Negotiated Rate	$154.56
Rate for Payer: Qualcare PPO/HMO/WC	$154.56

EPOETIN INJ 14,000U/1ML

Facility

$1,030.40

Hospital Charge Code	60629066
Hospital Revenue Code	250
Min. Negotiated Rate	$24.83
Max. Negotiated Rate	$515.20
Rate for Payer: Aetna Commercial	$391.55
Rate for Payer: Aetna Medicare Advantage	$309.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.75
Rate for Payer: Cigna Commercial	$515.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.12
Rate for Payer: Oxford Commercial	$206.08
Rate for Payer: Qualcare PPO/HMO/WC	$154.56
Rate for Payer: UnitedHealthcare Commercial	$206.08
Rate for Payer: UnitedHealthcare Community & State	$24.83
Rate for Payer: Wellpoint Medicaid Managed Care	$27.31

EPOETIN INJ 15,000U/1ML

Facility

$1,104.00

Hospital Charge Code	60629067
Hospital Revenue Code	250
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$552.00
Rate for Payer: Aetna Commercial	$419.52
Rate for Payer: Aetna Medicare Advantage	$331.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.52
Rate for Payer: Cigna Commercial	$552.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.20
Rate for Payer: Oxford Commercial	$220.80
Rate for Payer: Qualcare PPO/HMO/WC	$165.60
Rate for Payer: UnitedHealthcare Commercial	$220.80
Rate for Payer: UnitedHealthcare Community & State	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$29.26

EPOETIN INJ 15,000U/1ML

Facility

$1,104.00

Hospital Charge Code	60629067
Hospital Revenue Code	250
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$165.60
Rate for Payer: Qualcare PPO/HMO/WC	$165.60

EPOETIN INJ 16,000U/1ML

Facility

$1,177.60

Hospital Charge Code	606290068
Hospital Revenue Code	250
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$588.80
Rate for Payer: Aetna Commercial	$447.49
Rate for Payer: Aetna Medicare Advantage	$353.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.29
Rate for Payer: Cigna Commercial	$588.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.28
Rate for Payer: Oxford Commercial	$235.52
Rate for Payer: Qualcare PPO/HMO/WC	$176.64
Rate for Payer: UnitedHealthcare Commercial	$235.52
Rate for Payer: UnitedHealthcare Community & State	$28.38
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

EPOETIN INJ 16,000U/1ML

Facility

$1,177.60

Service Code	HCPCS J0886
Hospital Charge Code	60629068
Hospital Revenue Code	635
Min. Negotiated Rate	$176.64
Max. Negotiated Rate	$176.64
Rate for Payer: Qualcare PPO/HMO/WC	$176.64

EPOETIN INJ 16,000U/1ML

Facility

$1,177.60

Hospital Charge Code	606290068
Hospital Revenue Code	250
Min. Negotiated Rate	$176.64
Max. Negotiated Rate	$176.64
Rate for Payer: Qualcare PPO/HMO/WC	$176.64

EPOETIN INJ 16,000U/1ML

Facility

$1,177.60

Service Code	HCPCS J0886
Hospital Charge Code	60629068
Hospital Revenue Code	635
Min. Negotiated Rate	$28.38
Max. Negotiated Rate	$588.80
Rate for Payer: Aetna Commercial	$447.49
Rate for Payer: Aetna Medicare Advantage	$353.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.29
Rate for Payer: Cigna Commercial	$588.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.28
Rate for Payer: Oxford Commercial	$235.52
Rate for Payer: Qualcare PPO/HMO/WC	$176.64
Rate for Payer: UnitedHealthcare Commercial	$235.52
Rate for Payer: UnitedHealthcare Community & State	$28.38
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

EPOETIN INJ 17,000U/1ML

Facility

$1,251.20

Hospital Charge Code	60629069
Hospital Revenue Code	250
Min. Negotiated Rate	$187.68
Max. Negotiated Rate	$187.68
Rate for Payer: Qualcare PPO/HMO/WC	$187.68

EPOETIN INJ 17,000U/1ML

Facility

$1,251.20

Hospital Charge Code	60629069
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$625.60
Rate for Payer: Aetna Commercial	$475.46
Rate for Payer: Aetna Medicare Advantage	$375.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.06
Rate for Payer: Cigna Commercial	$625.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.36
Rate for Payer: Oxford Commercial	$250.24
Rate for Payer: Qualcare PPO/HMO/WC	$187.68
Rate for Payer: UnitedHealthcare Commercial	$250.24
Rate for Payer: UnitedHealthcare Community & State	$30.15
Rate for Payer: Wellpoint Medicaid Managed Care	$33.16

EPOETIN INJ 18,000U/1ML

Facility

$1,325.45

Hospital Charge Code	60629070
Hospital Revenue Code	250
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$198.82
Rate for Payer: Qualcare PPO/HMO/WC	$198.82

EPOETIN INJ 18,000U/1ML

Facility

$1,325.45

Hospital Charge Code	60629070
Hospital Revenue Code	250
Min. Negotiated Rate	$31.94
Max. Negotiated Rate	$662.73
Rate for Payer: Aetna Commercial	$503.67
Rate for Payer: Aetna Medicare Advantage	$397.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.99
Rate for Payer: Cigna Commercial	$662.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.63
Rate for Payer: Oxford Commercial	$265.09
Rate for Payer: Qualcare PPO/HMO/WC	$198.82
Rate for Payer: UnitedHealthcare Commercial	$265.09
Rate for Payer: UnitedHealthcare Community & State	$31.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.12

EPOETIN INJ 19,000U/1ML

Facility

$1,397.80

Hospital Charge Code	60629071
Hospital Revenue Code	250
Min. Negotiated Rate	$209.67
Max. Negotiated Rate	$209.67
Rate for Payer: Qualcare PPO/HMO/WC	$209.67

EPOETIN INJ 19,000U/1ML

Facility

$1,397.80

Hospital Charge Code	60629071
Hospital Revenue Code	250
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$698.90
Rate for Payer: Aetna Commercial	$531.16
Rate for Payer: Aetna Medicare Advantage	$419.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.44
Rate for Payer: Cigna Commercial	$698.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.34
Rate for Payer: Oxford Commercial	$279.56
Rate for Payer: Qualcare PPO/HMO/WC	$209.67
Rate for Payer: UnitedHealthcare Commercial	$279.56
Rate for Payer: UnitedHealthcare Community & State	$33.69
Rate for Payer: Wellpoint Medicaid Managed Care	$37.04

EPOETIN INJ 1OMU/1ML NONRENAL

Facility

$956.85

Hospital Charge Code	60629082
Hospital Revenue Code	636
Min. Negotiated Rate	$143.53
Max. Negotiated Rate	$231.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.56
Rate for Payer: Qualcare PPO/HMO/WC	$143.53

Know your out-of-pocket cost for care.

All Charges