Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$143.09
Max. Negotiated Rate	$143.09
Rate for Payer: Qualcare PPO/HMO/WC	$143.09

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$22.99
Max. Negotiated Rate	$476.98
Rate for Payer: Aetna Commercial	$362.50
Rate for Payer: Aetna Medicare Advantage	$286.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.26
Rate for Payer: Cigna Commercial	$476.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.19
Rate for Payer: Oxford Commercial	$190.79
Rate for Payer: Qualcare PPO/HMO/WC	$143.09
Rate for Payer: UnitedHealthcare Commercial	$190.79
Rate for Payer: UnitedHealthcare Community & State	$22.99
Rate for Payer: Wellpoint Medicaid Managed Care	$25.28

ETHANOLAMINEOLEATE 50MG/ML 2ML

Facility

$1,563.78

Service Code	HCPCS J1430
Hospital Charge Code	60632280
Hospital Revenue Code	636
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$378.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.43
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

ETHANOLAMINEOLEATE 50MG/ML 2ML

Facility

$1,563.78

Service Code	HCPCS J1430
Hospital Charge Code	60632280
Hospital Revenue Code	636
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$1,872.10
Rate for Payer: Aetna Commercial	$1,410.67
Rate for Payer: Aetna Medicare Advantage	$1,680.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$518.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,872.10
Rate for Payer: Cigna Medicare Advantage	$518.63
Rate for Payer: Clover Medicare Advantage	$492.70
Rate for Payer: EmblemHealth Commercial	$1,555.89
Rate for Payer: Humana Medicare Advantage	$534.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$518.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.43
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Community & State	$37.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$518.63
Rate for Payer: Wellcare Medicare Advantage	$518.63
Rate for Payer: Wellpoint Medicaid Managed Care	$41.44

ETHICON CAP(384.75)+RETRACTOR

Facility

$707.00

Hospital Charge Code	270335972
Hospital Revenue Code	272
Min. Negotiated Rate	$106.05
Max. Negotiated Rate	$106.05
Rate for Payer: Qualcare PPO/HMO/WC	$106.05

ETHICON CAP(384.75)+RETRACTOR

Facility

$707.00

Hospital Charge Code	270335972
Hospital Revenue Code	272
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$353.50
Rate for Payer: Aetna Commercial	$268.66
Rate for Payer: Aetna Medicare Advantage	$212.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.28
Rate for Payer: Cigna Commercial	$353.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.10
Rate for Payer: Oxford Commercial	$141.40
Rate for Payer: Qualcare PPO/HMO/WC	$106.05
Rate for Payer: UnitedHealthcare Commercial	$141.40
Rate for Payer: UnitedHealthcare Community & State	$17.04
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

ETHICON PHYSIOMESH

Facility

$345.00

Hospital Charge Code	270335977
Hospital Revenue Code	278
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare Advantage	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Community & State	$8.31
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

ETHICON PHYSIOMESH

Facility

$345.00

Hospital Charge Code	270335977
Hospital Revenue Code	278
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

ETHICON P MESH-PHY151V 15X15CM

Facility

$843.00

Hospital Charge Code	270335978
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.50
Rate for Payer: Aetna Commercial	$320.34
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.46
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.34

ETHICON P MESH-PHY151V 15X15CM

Facility

$843.00

Hospital Charge Code	270335978
Hospital Revenue Code	278
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$204.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.46
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

ETHIPACK STEEL 2-0 18 STRANDS

Facility

$56.75

Hospital Charge Code	270625530
Hospital Revenue Code	272
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$8.51
Rate for Payer: Qualcare PPO/HMO/WC	$8.51

ETHIPACK STEEL 2-0 18 STRANDS

Facility

$56.75

Hospital Charge Code	270625530
Hospital Revenue Code	272
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.38
Rate for Payer: Aetna Commercial	$21.57
Rate for Payer: Aetna Medicare Advantage	$17.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.47
Rate for Payer: Cigna Commercial	$28.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.02
Rate for Payer: Oxford Commercial	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$8.51
Rate for Payer: UnitedHealthcare Commercial	$11.35
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

ETHIPACK STEEL 3-0 18 STR DS30

Facility

$59.60

Hospital Charge Code	270625531
Hospital Revenue Code	272
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$8.94
Rate for Payer: Qualcare PPO/HMO/WC	$8.94

ETHIPACK STEEL 3-0 18 STR DS30

Facility

$59.60

Hospital Charge Code	270625531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$22.65
Rate for Payer: Aetna Medicare Advantage	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.20
Rate for Payer: Cigna Commercial	$29.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.88
Rate for Payer: Oxford Commercial	$11.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.94
Rate for Payer: UnitedHealthcare Commercial	$11.92
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.58

ETHMOZINE/200MG/TAB

Facility

$6.00

Hospital Charge Code	60632962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ETHMOZINE/200MG/TAB

Facility

$6.00

Hospital Charge Code	60632962
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ETHMOZINE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632963
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ETHMOZINE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632963
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ETHMOZINE/300MG/TAB

Facility

$8.00

Hospital Charge Code	60632964
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

ETHMOZINE/300MG/TAB

Facility

$8.00

Hospital Charge Code	60632964
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ETHOSUXIMIDE, SERUM

Facility

$170.45

Service Code	HCPCS 80168
Hospital Charge Code	3003993
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.44
Rate for Payer: Aetna Medicare Advantage	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.98
Rate for Payer: Cigna Commercial	$85.22
Rate for Payer: Cigna Medicare Advantage	$16.34
Rate for Payer: Clover Medicare Advantage	$15.52
Rate for Payer: EmblemHealth Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$16.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.34
Rate for Payer: Wellcare Medicare Advantage	$16.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

ETHOSUXIMIDE, SERUM

Facility

$170.45

Service Code	HCPCS 80168
Hospital Charge Code	3003993
Hospital Revenue Code	301
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

ETHRANE/125ML

Facility

$533.00

Hospital Charge Code	60634425
Hospital Revenue Code	250
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$79.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.95

ETHRANE/125ML

Facility

$533.00

Hospital Charge Code	60634425
Hospital Revenue Code	250
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$266.50
Rate for Payer: Aetna Commercial	$202.54
Rate for Payer: Aetna Medicare Advantage	$159.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.91
Rate for Payer: Cigna Commercial	$266.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.90
Rate for Payer: Oxford Commercial	$106.60
Rate for Payer: Qualcare PPO/HMO/WC	$79.95
Rate for Payer: UnitedHealthcare Commercial	$106.60
Rate for Payer: UnitedHealthcare Community & State	$12.85
Rate for Payer: Wellpoint Medicaid Managed Care	$14.12

ETHRANE/250ML

Facility

$806.00

Hospital Charge Code	60634426
Hospital Revenue Code	250
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$120.90

Know your out-of-pocket cost for care.

All Charges