Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ERYTHROPOIETIN INJ 1,000U

Facility

$48.00

Hospital Charge Code	6017420
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

ERYTHROPOIETIN INJ 5,000U***

Facility

$117.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017438
Hospital Revenue Code	634
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

ERYTHROPOIETIN INJ 5,000U***

Facility

$117.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017438
Hospital Revenue Code	634
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: Oxford Commercial	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$23.40
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

ERYTHROPOIETIN INJ 6,000U****

Facility

$140.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017347
Hospital Revenue Code	634
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

ERYTHROPOIETIN INJ 6,000U****

Facility

$140.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017347
Hospital Revenue Code	634
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

ERYTHROPOIETIN INJ 7,000U***

Facility

$164.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017446
Hospital Revenue Code	634
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

ERYTHROPOIETIN INJ 7,000U***

Facility

$164.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017446
Hospital Revenue Code	634
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$82.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$32.80
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$32.80
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

ERYTHROPOIETIN INJ 8,000U***

Facility

$187.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017354
Hospital Revenue Code	634
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$28.05
Rate for Payer: Qualcare PPO/HMO/WC	$28.05

ERYTHROPOIETIN INJ 8,000U***

Facility

$187.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017354
Hospital Revenue Code	634
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$93.50
Rate for Payer: Aetna Commercial	$71.06
Rate for Payer: Aetna Medicare Advantage	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.69
Rate for Payer: Cigna Commercial	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.10
Rate for Payer: Oxford Commercial	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.05
Rate for Payer: UnitedHealthcare Commercial	$37.40
Rate for Payer: UnitedHealthcare Community & State	$4.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

ERYTHROPOIETIN INJ 9,000***

Facility

$211.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017453
Hospital Revenue Code	634
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$105.50
Rate for Payer: Aetna Commercial	$80.18
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.30
Rate for Payer: Oxford Commercial	$42.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$42.20
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

ERYTHROPOIETIN INJ 9,000***

Facility

$211.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017453
Hospital Revenue Code	634
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

ERYTHROPOIETIN SERUM

Facility

$218.45

Service Code	HCPCS 82668
Hospital Charge Code	3004140
Hospital Revenue Code	301
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

ERYTHROPOIETIN SERUM

Facility

$218.45

Service Code	HCPCS 82668
Hospital Charge Code	3004140
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$51.11
Rate for Payer: Aetna Medicare Advantage	$60.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: Cigna Medicare Advantage	$18.79
Rate for Payer: Clover Medicare Advantage	$17.85
Rate for Payer: EmblemHealth Commercial	$56.37
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.79
Rate for Payer: Wellcare Medicare Advantage	$18.79
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

ESCHAROTOMY SUBSEQUENT

Facility

$250.00

Service Code	HCPCS 16036
Hospital Charge Code	5780010
Hospital Revenue Code	450
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

ESCHAROTOMY SUBSEQUENT

Facility

$250.00

Service Code	HCPCS 16036
Hospital Charge Code	5780010
Hospital Revenue Code	450
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ESCITALOPRAM 10 MG TAB

Facility

$55.07

Service Code	NDC 904642661
Hospital Charge Code	60629342
Hospital Revenue Code	250
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$8.26
Rate for Payer: Qualcare PPO/HMO/WC	$8.26

ESCITALOPRAM 10 MG TAB

Facility

$55.07

Service Code	NDC 904642661
Hospital Charge Code	60629342
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.54
Rate for Payer: Aetna Commercial	$20.93
Rate for Payer: Aetna Medicare Advantage	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.04
Rate for Payer: Cigna Commercial	$27.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.52
Rate for Payer: Oxford Commercial	$11.01
Rate for Payer: Qualcare PPO/HMO/WC	$8.26
Rate for Payer: UnitedHealthcare Commercial	$11.01
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

ESCITALOPRAM 20 MG TAB

Facility

$56.35

Service Code	NDC 456202001
Hospital Charge Code	60629343
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$8.45
Rate for Payer: Qualcare PPO/HMO/WC	$8.45

ESCITALOPRAM 20 MG TAB

Facility

$56.35

Service Code	NDC 456202001
Hospital Charge Code	60629343
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$21.41
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.37
Rate for Payer: Cigna Commercial	$28.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.91
Rate for Payer: Oxford Commercial	$11.27
Rate for Payer: Qualcare PPO/HMO/WC	$8.45
Rate for Payer: UnitedHealthcare Commercial	$11.27
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

ESCITALOPRAM (LEXAPRO) 5MG TAB

Facility

$27.74

Service Code	NDC 93585001
Hospital Charge Code	60630130
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.16

ESCITALOPRAM (LEXAPRO) 5MG TAB

Facility

$27.74

Service Code	NDC 93585001
Hospital Charge Code	60630130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.87
Rate for Payer: Aetna Commercial	$10.54
Rate for Payer: Aetna Medicare Advantage	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.07
Rate for Payer: Cigna Commercial	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.16
Rate for Payer: UnitedHealthcare Commercial	$5.55
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

ES-EPSTEIN BARR

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38479429
Hospital Revenue Code	306
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

ES-EPSTEIN BARR

Facility

$109.00

Service Code	HCPCS 86664
Hospital Charge Code	38479428
Hospital Revenue Code	302
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

ES-EPSTEIN BARR

Facility

$109.00

Service Code	HCPCS 86664
Hospital Charge Code	38479428
Hospital Revenue Code	302
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.19
Rate for Payer: Cigna Commercial	$54.50
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

ES-EPSTEIN BARR

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38479429
Hospital Revenue Code	306
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.29
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

Know your out-of-pocket cost for care.

All Charges