Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHLOROTHIAZIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60627961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLOROXINE 2% SHA

Facility

$178.45

Hospital Charge Code	60628330
Hospital Revenue Code	250
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$89.22
Rate for Payer: Aetna Commercial	$67.81
Rate for Payer: Aetna Medicare Advantage	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.53
Rate for Payer: Oxford Commercial	$35.69
Rate for Payer: Qualcare PPO/HMO/WC	$26.77
Rate for Payer: UnitedHealthcare Commercial	$35.69
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4.73

CHLOROXINE 2% SHA

Facility

$178.45

Hospital Charge Code	60628330
Hospital Revenue Code	250
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$26.77
Rate for Payer: Qualcare PPO/HMO/WC	$26.77

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

CHLORPACIN WCS-90 2 GM

Facility

$25.25

Hospital Charge Code	60628353W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$7.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.44
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.58
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

CHLORPACTIN POWDER 2GM

Facility

$290.60

Hospital Charge Code	6006779
Hospital Revenue Code	252
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$145.30
Rate for Payer: Aetna Commercial	$110.43
Rate for Payer: Aetna Medicare Advantage	$87.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.10
Rate for Payer: Cigna Commercial	$145.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.18
Rate for Payer: Oxford Commercial	$58.12
Rate for Payer: Qualcare PPO/HMO/WC	$43.59
Rate for Payer: UnitedHealthcare Commercial	$58.12
Rate for Payer: UnitedHealthcare Community & State	$7.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.70

CHLORPACTIN POWDER 2GM

Facility

$290.60

Hospital Charge Code	6006779
Hospital Revenue Code	252
Min. Negotiated Rate	$43.59
Max. Negotiated Rate	$43.59
Rate for Payer: Qualcare PPO/HMO/WC	$43.59

CHLORPACTIN VL

Facility

$21.15

Hospital Charge Code	6012363
Hospital Revenue Code	252
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CHLORPACTIN VL

Facility

$21.15

Hospital Charge Code	6012363
Hospital Revenue Code	252
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

CHLORPHENIRAMINE 4 MG TAB

Facility

$2.45

Hospital Charge Code	60627221
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

CHLORPHENIRAMINE 4 MG TAB

Facility

$2.45

Hospital Charge Code	60627221
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632686
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632687
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60634357
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60632687
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

CHLORPHENIRAMINE MALEATE

Facility

$3.00

Hospital Charge Code	60634357
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CHLORPHENIRAM PHENYLEPH 118ML

Facility

$82.55

Hospital Charge Code	60627222
Hospital Revenue Code	251
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

CHLORPHENIRAM PHENYLEPH 118ML

Facility

$82.55

Hospital Charge Code	60627222
Hospital Revenue Code	251
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.27
Rate for Payer: Aetna Commercial	$31.37
Rate for Payer: Aetna Medicare Advantage	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.05
Rate for Payer: Cigna Commercial	$41.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.77
Rate for Payer: Oxford Commercial	$16.51
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$16.51
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

CHLORPHENIRAM PSEUDOEPH LQ

Facility

$37.80

Hospital Charge Code	6001168
Hospital Revenue Code	251
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

CHLORPHENIRAM PSEUDOEPH LQ

Facility

$37.80

Hospital Charge Code	6001168
Hospital Revenue Code	251
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

CHLORPHEN PHENTOL PE PPA DROPS

Facility

$138.25

Hospital Charge Code	60628909
Hospital Revenue Code	250
Min. Negotiated Rate	$20.74
Max. Negotiated Rate	$20.74
Rate for Payer: Qualcare PPO/HMO/WC	$20.74

CHLORPHEN PHENTOL PE PPA DROPS

Facility

$138.25

Hospital Charge Code	60628909
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$69.12
Rate for Payer: Aetna Commercial	$52.53
Rate for Payer: Aetna Medicare Advantage	$41.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.25
Rate for Payer: Cigna Commercial	$69.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.48
Rate for Payer: Oxford Commercial	$27.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.74
Rate for Payer: UnitedHealthcare Commercial	$27.65
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$56.62
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.00
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$29.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$29.80
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CHLORPROMAZINE 100 MG TAB

Facility

$149.01

Service Code	NDC 51079051620
Hospital Charge Code	60627787
Hospital Revenue Code	250
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

Know your out-of-pocket cost for care.

All Charges