Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PALACOS R+G SINGLE 1 X 40

Facility

$2,000.00

Hospital Charge Code	270658749
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PALIPERIDONE 1.5MG ER TABLETS

Facility

$204.48

Service Code	NDC 10147095103
Hospital Charge Code	606390238
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$102.24
Rate for Payer: Aetna Commercial	$77.70
Rate for Payer: Aetna Medicare Advantage	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.14
Rate for Payer: Cigna Commercial	$102.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.34
Rate for Payer: Oxford Commercial	$40.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.67
Rate for Payer: UnitedHealthcare Commercial	$40.90
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: Wellpoint Medicaid Managed Care	$5.42

PALIPERIDONE 1.5MG ER TABLETS

Facility

$204.48

Service Code	NDC 10147095103
Hospital Charge Code	606390238
Hospital Revenue Code	250
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$30.67
Rate for Payer: Qualcare PPO/HMO/WC	$30.67

PALIPERIDONE 3MG TAB

Facility

$154.70

Service Code	NDC 35356045030
Hospital Charge Code	6063943156
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

PALIPERIDONE 3MG TAB

Facility

$154.70

Service Code	NDC 35356045030
Hospital Charge Code	6063943156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$58.79
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Oxford Commercial	$30.94
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$30.94
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

PALIPERIDONE 6MG TAB

Facility

$323.74

Service Code	NDC 50458055101
Hospital Charge Code	6063943157
Hospital Revenue Code	250
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$48.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.56

PALIPERIDONE 6MG TAB

Facility

$323.74

Service Code	NDC 50458055101
Hospital Charge Code	6063943157
Hospital Revenue Code	250
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$161.87
Rate for Payer: Aetna Commercial	$123.02
Rate for Payer: Aetna Medicare Advantage	$97.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.55
Rate for Payer: Cigna Commercial	$161.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.12
Rate for Payer: Oxford Commercial	$64.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.56
Rate for Payer: UnitedHealthcare Commercial	$64.75
Rate for Payer: UnitedHealthcare Community & State	$7.80
Rate for Payer: Wellpoint Medicaid Managed Care	$8.58

PALIVIZUMAB 50 MG/0.5 ML ML

Facility

$10,511.16

Service Code	NDC 60574411401
Hospital Charge Code	6063943225
Hospital Revenue Code	250
Min. Negotiated Rate	$1,576.67
Max. Negotiated Rate	$1,576.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.67

PALIVIZUMAB 50 MG/0.5 ML ML

Facility

$10,511.16

Service Code	NDC 60574411401
Hospital Charge Code	6063943225
Hospital Revenue Code	250
Min. Negotiated Rate	$253.32
Max. Negotiated Rate	$5,255.58
Rate for Payer: Aetna Commercial	$3,994.24
Rate for Payer: Aetna Medicare Advantage	$3,153.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,680.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,680.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,680.35
Rate for Payer: Cigna Commercial	$5,255.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.35
Rate for Payer: Oxford Commercial	$2,102.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.67
Rate for Payer: UnitedHealthcare Commercial	$2,102.23
Rate for Payer: UnitedHealthcare Community & State	$253.32
Rate for Payer: Wellpoint Medicaid Managed Care	$278.55

PALOCOS CEMENT W/ GENTOPRYC

Facility

$2,000.00

Hospital Charge Code	270656062
Hospital Revenue Code	272
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PALOCOS CEMENT W/ GENTOPRYC

Facility

$2,000.00

Hospital Charge Code	270656062
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PALOCOS CEMENT W/ GENTOPRYCIN

Facility

$2,000.05

Hospital Charge Code	27065602
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.02
Rate for Payer: Aetna Commercial	$760.02
Rate for Payer: Aetna Medicare Advantage	$600.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.01
Rate for Payer: Cigna Commercial	$1,000.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PALOCOS CEMENT W/ GENTOPRYCIN

Facility

$2,000.05

Hospital Charge Code	27065602
Hospital Revenue Code	278
Min. Negotiated Rate	$300.01
Max. Negotiated Rate	$484.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01

PAMELOR 10MG/5ML

Facility

$2.00

Hospital Charge Code	60635685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PAMELOR 10MG/5ML

Facility

$2.00

Hospital Charge Code	60635685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PAMELOR/10MG/5ML

Facility

$238.00

Hospital Charge Code	60633600
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

PAMELOR/10MG/5ML

Facility

$238.00

Hospital Charge Code	60633600
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$119.00
Rate for Payer: Aetna Commercial	$90.44
Rate for Payer: Aetna Medicare Advantage	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.69
Rate for Payer: Cigna Commercial	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.40
Rate for Payer: Oxford Commercial	$47.60
Rate for Payer: Qualcare PPO/HMO/WC	$35.70
Rate for Payer: UnitedHealthcare Commercial	$47.60
Rate for Payer: UnitedHealthcare Community & State	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.31

PAMELOR/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PAMELOR/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633604
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

PAMELOR/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PAMELOR/10MG/CAP

Facility

$3.00

Hospital Charge Code	60633603
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

PAMELOR/25MG/CAP

Facility

$5.00

Hospital Charge Code	60633605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PAMELOR/25MG/CAP

Facility

$5.00

Hospital Charge Code	60633605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

PAMELOR/50MG/CAP

Facility

$12.00

Hospital Charge Code	60633602
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

PAMELOR/50MG/CAP

Facility

$12.00

Hospital Charge Code	60633602
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

Know your out-of-pocket cost for care.

All Charges