Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ETHRANE/250ML

Facility

$806.00

Hospital Charge Code	60634426
Hospital Revenue Code	250
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$403.00
Rate for Payer: Aetna Commercial	$306.28
Rate for Payer: Aetna Medicare Advantage	$241.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.53
Rate for Payer: Cigna Commercial	$403.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.80
Rate for Payer: Oxford Commercial	$161.20
Rate for Payer: Qualcare PPO/HMO/WC	$120.90
Rate for Payer: UnitedHealthcare Commercial	$161.20
Rate for Payer: UnitedHealthcare Community & State	$19.42
Rate for Payer: Wellpoint Medicaid Managed Care	$21.36

ETHYL ALCOHOL

Facility

$662.29

Service Code	HCPCS 80320
Hospital Charge Code	3000411
Hospital Revenue Code	301
Min. Negotiated Rate	$99.34
Max. Negotiated Rate	$99.34
Rate for Payer: Qualcare PPO/HMO/WC	$99.34

ETHYL ALCOHOL

Facility

$662.29

Service Code	HCPCS 80320
Hospital Charge Code	3000411
Hospital Revenue Code	301
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$331.14
Rate for Payer: Aetna Commercial	$251.67
Rate for Payer: Aetna Medicare Advantage	$198.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.88
Rate for Payer: Cigna Commercial	$331.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.34
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.55

ETHYL ALCOHOL 95% GALLON

Facility

$34.60

Hospital Charge Code	6012538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

ETHYL ALCOHOL 95% GALLON

Facility

$34.60

Hospital Charge Code	6012538
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ETHYL CHLORIDE 100% TOP SPRAY

Facility

$100.00

Hospital Charge Code	60628413
Hospital Revenue Code	250
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

ETHYL CHLORIDE 100% TOP SPRAY

Facility

$100.00

Hospital Charge Code	60628413
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

ETHYL CHLORIDE SPRAY

Facility

$62.10

Hospital Charge Code	6012546
Hospital Revenue Code	252
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

ETHYL CHLORIDE SPRAY

Facility

$62.10

Hospital Charge Code	6012546
Hospital Revenue Code	252
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

ETHYLENE GLYCO

Facility

$103.25

Service Code	HCPCS 82963
Hospital Charge Code	3007380
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

ETHYLENE GLYCO

Facility

$103.25

Service Code	HCPCS 82963
Hospital Charge Code	3007380
Hospital Revenue Code	301
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$58.43
Rate for Payer: Aetna Medicare Advantage	$69.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.54
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$21.48
Rate for Payer: Clover Medicare Advantage	$20.41
Rate for Payer: EmblemHealth Commercial	$64.44
Rate for Payer: Humana Medicare Advantage	$22.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.48
Rate for Payer: Wellcare Medicare Advantage	$21.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$40.53
Rate for Payer: Aetna Medicare Advantage	$48.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.78
Rate for Payer: Cigna Commercial	$200.50
Rate for Payer: Cigna Medicare Advantage	$14.90
Rate for Payer: Clover Medicare Advantage	$14.15
Rate for Payer: EmblemHealth Commercial	$44.70
Rate for Payer: Humana Medicare Advantage	$15.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.90
Rate for Payer: Wellcare Medicare Advantage	$14.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

ETHYLOL 500MG INJ VIAL

Facility

$730.00

Hospital Charge Code	60635371
Hospital Revenue Code	636
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$176.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

ETHYLOL 500MG INJ VIAL

Facility

$730.00

Hospital Charge Code	60635371
Hospital Revenue Code	636
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$277.40
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

ETIDOCAINE 1% PF INJ

Facility

$5.65

Hospital Charge Code	6002356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

ETIDOCAINE 1% PF INJ

Facility

$5.65

Hospital Charge Code	6002356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

ETIDRONATE 200 MG TAB

Facility

$20.85

Hospital Charge Code	60628528
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

ETIDRONATE 200 MG TAB

Facility

$20.85

Hospital Charge Code	60628528
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

ETIDRONATE 300 MG/6ML INJ

Facility

$67.50

Hospital Charge Code	60628529
Hospital Revenue Code	636
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$25.65
Rate for Payer: Aetna Medicare Advantage	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.21
Rate for Payer: Cigna Commercial	$33.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

ETIDRONATE 300 MG/6ML INJ

Facility

$67.50

Hospital Charge Code	60628529
Hospital Revenue Code	636
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

ETIDRONATE 300 MG INJ

Facility

$258.00

Hospital Charge Code	60632838
Hospital Revenue Code	250
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

ETIDRONATE 300 MG INJ

Facility

$258.00

Hospital Charge Code	60632838
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$51.60
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

ETIDRONATE DISODIUM INJ 300MG

Facility

$285.45

Hospital Charge Code	6016380
Hospital Revenue Code	636
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$69.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82

ETIDRONATE DISODIUM INJ 300MG

Facility

$285.45

Hospital Charge Code	6016380
Hospital Revenue Code	636
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$142.72
Rate for Payer: Aetna Commercial	$108.47
Rate for Payer: Aetna Medicare Advantage	$85.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.79
Rate for Payer: Cigna Commercial	$142.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82
Rate for Payer: UnitedHealthcare Community & State	$6.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.56

Know your out-of-pocket cost for care.

All Charges