Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ESTROGEN TOTAL

Facility

$633.00

Service Code	HCPCS 82672
Hospital Charge Code	38472272
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

ESTROL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38479405
Hospital Revenue Code	301
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

ESTROL

Facility

$520.00

Service Code	HCPCS 82677
Hospital Charge Code	38479405
Hospital Revenue Code	301
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$65.77
Rate for Payer: Aetna Medicare Advantage	$78.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.28
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: Cigna Medicare Advantage	$24.18
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Medicare Advantage	$24.18
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

ESTRONE

Facility

$176.74

Service Code	HCPCS 82679
Hospital Charge Code	38477176
Hospital Revenue Code	301
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$67.86
Rate for Payer: Aetna Medicare Advantage	$80.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$90.06
Rate for Payer: Cigna Commercial	$88.37
Rate for Payer: Cigna Medicare Advantage	$24.95
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.51
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.95
Rate for Payer: Wellcare Medicare Advantage	$24.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.68

ESTRONE

Facility

$176.74

Service Code	HCPCS 82679
Hospital Charge Code	38477176
Hospital Revenue Code	301
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Qualcare PPO/HMO/WC	$26.51

ESTRONE

Facility

$119.00

Service Code	HCPCS 82379
Hospital Charge Code	38478113
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

ESTRONE

Facility

$119.00

Service Code	HCPCS 82379
Hospital Charge Code	38478113
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.90
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

ESTRONE (E1)

Facility

$233.65

Service Code	HCPCS 82679
Hospital Charge Code	3009994
Hospital Revenue Code	301
Min. Negotiated Rate	$35.05
Max. Negotiated Rate	$35.05
Rate for Payer: Qualcare PPO/HMO/WC	$35.05

ESTRONE (E1)

Facility

$233.65

Service Code	HCPCS 82679
Hospital Charge Code	3009994
Hospital Revenue Code	301
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$67.86
Rate for Payer: Aetna Medicare Advantage	$80.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$90.06
Rate for Payer: Cigna Commercial	$116.83
Rate for Payer: Cigna Medicare Advantage	$24.95
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.95
Rate for Payer: Wellcare Medicare Advantage	$24.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.19

ESTRONE,SERUM

Facility

$390.00

Service Code	HCPCS 82679
Hospital Charge Code	39900077
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ESTRONE,SERUM

Facility

$390.00

Service Code	HCPCS 82679
Hospital Charge Code	39900077
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$67.86
Rate for Payer: Aetna Medicare Advantage	$80.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$90.06
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.95
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.95
Rate for Payer: Wellcare Medicare Advantage	$24.95
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ESTRONE SSP INJ 2MG/ML 10ML

Facility

$70.40

Hospital Charge Code	6002331
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

ESTRONE SSP INJ 2MG/ML 10ML

Facility

$70.40

Hospital Charge Code	6002331
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

ETHACRYNIC ACID 25 MG TAB

Facility

$5.85

Hospital Charge Code	60628615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

ETHACRYNIC ACID 25 MG TAB

Facility

$5.85

Hospital Charge Code	60628615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ETHACRYNIC ACID 50 MG INJ

Facility

$168.00

Hospital Charge Code	60629013
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

ETHACRYNIC ACID 50 MG INJ

Facility

$168.00

Hospital Charge Code	60629013
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

ETHACRYNIC ACID INJ 50MG

Facility

$113.30

Hospital Charge Code	6002349
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

ETHACRYNIC ACID INJ 50MG

Facility

$113.30

Hospital Charge Code	6002349
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$43.05
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.99
Rate for Payer: Oxford Commercial	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.66
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

ETHAMBUTOL

Facility

$309.00

Service Code	HCPCS 80299
Hospital Charge Code	3009822
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$154.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$154.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.19

ETHAMBUTOL

Facility

$309.00

Service Code	HCPCS 80299
Hospital Charge Code	3009822
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

ETHAMBUTOL 400 MG TAB

Facility

$11.93

Service Code	NDC 68850001202
Hospital Charge Code	6009435
Hospital Revenue Code	251
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

ETHAMBUTOL 400 MG TAB

Facility

$11.93

Service Code	NDC 68850001202
Hospital Charge Code	6009435
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.58
Rate for Payer: Oxford Commercial	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$2.39
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges