Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ESKALITH CR/450MG/TAB

Facility

$3.00

Hospital Charge Code	60634381
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ESKALITH CR/450MG/TAB

Facility

$3.00

Hospital Charge Code	60634381
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ESKLITH CR

Facility

$3.00

Hospital Charge Code	60634484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ESKLITH CR

Facility

$3.00

Hospital Charge Code	60634484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ESLICARBAZEPINE

Facility

$529.45

Service Code	HCPCS 80339
Hospital Charge Code	401180339
Hospital Revenue Code	301
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$264.73
Rate for Payer: Aetna Commercial	$201.19
Rate for Payer: Aetna Medicare Advantage	$158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.01
Rate for Payer: Cigna Commercial	$264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.42
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$14.03

ESLICARBAZEPINE

Facility

$529.45

Service Code	HCPCS 80339
Hospital Charge Code	401180339
Hospital Revenue Code	301
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$79.42
Rate for Payer: Qualcare PPO/HMO/WC	$79.42

ESMOLOL 100 MG/10ML INJ

Facility

$147.87

Service Code	NDC 63323065210
Hospital Charge Code	60628613
Hospital Revenue Code	250
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

ESMOLOL 100 MG/10ML INJ

Facility

$147.87

Service Code	NDC 63323065210
Hospital Charge Code	60628613
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.94
Rate for Payer: Aetna Commercial	$56.19
Rate for Payer: Aetna Medicare Advantage	$44.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.71
Rate for Payer: Cigna Commercial	$73.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.36
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

ESMOLOL 2500 MG/10ML INJ

Facility

$884.87

Service Code	NDC 10019005561
Hospital Charge Code	60627563
Hospital Revenue Code	250
Min. Negotiated Rate	$132.73
Max. Negotiated Rate	$132.73
Rate for Payer: Qualcare PPO/HMO/WC	$132.73

ESMOLOL 2500 MG/10ML INJ

Facility

$884.87

Service Code	NDC 10019005561
Hospital Charge Code	60627563
Hospital Revenue Code	250
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$442.44
Rate for Payer: Aetna Commercial	$336.25
Rate for Payer: Aetna Medicare Advantage	$265.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.64
Rate for Payer: Cigna Commercial	$442.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: Oxford Commercial	$176.97
Rate for Payer: Qualcare PPO/HMO/WC	$132.73
Rate for Payer: UnitedHealthcare Commercial	$176.97
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$23.45

ESMOLOL(BREVIBLOCK)2500MG

Facility

$1,575.30

Service Code	NDC 10019005561
Hospital Charge Code	60630228
Hospital Revenue Code	250
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.65
Rate for Payer: Aetna Commercial	$598.61
Rate for Payer: Aetna Medicare Advantage	$472.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.70
Rate for Payer: Cigna Commercial	$787.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$472.59
Rate for Payer: Oxford Commercial	$315.06
Rate for Payer: Qualcare PPO/HMO/WC	$236.29
Rate for Payer: UnitedHealthcare Commercial	$315.06
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.75

ESMOLOL(BREVIBLOCK)2500MG

Facility

$1,575.30

Service Code	NDC 10019005561
Hospital Charge Code	60630228
Hospital Revenue Code	250
Min. Negotiated Rate	$236.29
Max. Negotiated Rate	$236.29
Rate for Payer: Qualcare PPO/HMO/WC	$236.29

ESMOLOL IVCI 100MG ISOML

Facility

$30.75

Hospital Charge Code	60628614
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: Qualcare PPO/HMO/WC	$4.61

ESMOLOL IVCI 100MG ISOML

Facility

$30.75

Hospital Charge Code	60628614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.84
Rate for Payer: Cigna Commercial	$15.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.22
Rate for Payer: Oxford Commercial	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.61
Rate for Payer: UnitedHealthcare Commercial	$6.15
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

ESMOLOL VIAL 250MG

Facility

$426.90

Hospital Charge Code	6012520
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$213.45
Rate for Payer: Aetna Commercial	$162.22
Rate for Payer: Aetna Medicare Advantage	$128.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.86
Rate for Payer: Cigna Commercial	$213.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.07
Rate for Payer: Oxford Commercial	$85.38
Rate for Payer: Qualcare PPO/HMO/WC	$64.03
Rate for Payer: UnitedHealthcare Commercial	$85.38
Rate for Payer: UnitedHealthcare Community & State	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.31

ESMOLOL VIAL 250MG

Facility

$426.90

Hospital Charge Code	6012520
Hospital Revenue Code	250
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$64.03
Rate for Payer: Qualcare PPO/HMO/WC	$64.03

ESOMEPRAZOLE 20 MG EC CAP

Facility

$26.35

Hospital Charge Code	60629898
Hospital Revenue Code	250
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.95

ESOMEPRAZOLE 20 MG EC CAP

Facility

$26.35

Hospital Charge Code	60629898
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.18
Rate for Payer: Aetna Commercial	$10.01
Rate for Payer: Aetna Medicare Advantage	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.72
Rate for Payer: Cigna Commercial	$13.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.91
Rate for Payer: Oxford Commercial	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.95
Rate for Payer: UnitedHealthcare Commercial	$5.27
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

ESOMEPRAZOLE 40 MG EC CAP

Facility

$35.10

Hospital Charge Code	60629126
Hospital Revenue Code	250
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$5.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.26

ESOMEPRAZOLE 40 MG EC CAP

Facility

$35.10

Hospital Charge Code	60629126
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$13.34
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.26
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

ESOMEPRAZOLE 40 MG INJ

Facility

$267.85

Hospital Charge Code	6063943355
Hospital Revenue Code	250
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$133.93
Rate for Payer: Aetna Commercial	$101.78
Rate for Payer: Aetna Medicare Advantage	$80.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$133.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.36
Rate for Payer: Oxford Commercial	$53.57
Rate for Payer: Qualcare PPO/HMO/WC	$40.18
Rate for Payer: UnitedHealthcare Commercial	$53.57
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

ESOMEPRAZOLE 40 MG INJ

Facility

$267.85

Hospital Charge Code	6063943355
Hospital Revenue Code	250
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$40.18
Rate for Payer: Qualcare PPO/HMO/WC	$40.18

ESOPHAGEAL DILATATION***

Facility

$149.60

Hospital Charge Code	2300473
Hospital Revenue Code	361
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$56.85
Rate for Payer: Aetna Medicare Advantage	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.15
Rate for Payer: Cigna Commercial	$74.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.44
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: Wellpoint Medicaid Managed Care	$3.96

ESOPHAGEAL DILATATION***

Facility

$149.60

Hospital Charge Code	2300473
Hospital Revenue Code	361
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$22.44
Rate for Payer: Qualcare PPO/HMO/WC	$22.44

ESOPHAGEAL DILATION****

Facility

$270.00

Service Code	HCPCS 43450
Hospital Charge Code	1001130
Hospital Revenue Code	361
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

Know your out-of-pocket cost for care.

All Charges