Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 20 MG ECT

Facility

$4.00

Service Code	NDC 8060601
Hospital Charge Code	60630100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PANTOPRAZOLE 20 MG ECT

Facility

$4.00

Service Code	NDC 8060601
Hospital Charge Code	60630100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PANTOPRAZOLE 40MG/100ML NACL

Facility

$192.96

Service Code	HCPCS J2470
Hospital Charge Code	60629227
Hospital Revenue Code	636
Min. Negotiated Rate	$28.94
Max. Negotiated Rate	$46.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.94

PANTOPRAZOLE 40MG/100ML NACL

Facility

$192.96

Service Code	HCPCS J2470
Hospital Charge Code	60629227
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.48
Rate for Payer: Aetna Commercial	$73.32
Rate for Payer: Aetna Medicare Advantage	$57.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.20
Rate for Payer: Cigna Commercial	$96.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.94
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

PANTOPRAZOLE INJ 400MG/1000DSW

Facility

$101.15

Hospital Charge Code	60629209
Hospital Revenue Code	250
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$15.17
Rate for Payer: Qualcare PPO/HMO/WC	$15.17

PANTOPRAZOLE INJ 400MG/1000DSW

Facility

$101.15

Hospital Charge Code	60629209
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$50.58
Rate for Payer: Aetna Commercial	$38.44
Rate for Payer: Aetna Medicare Advantage	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.79
Rate for Payer: Cigna Commercial	$50.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.34
Rate for Payer: Oxford Commercial	$20.23
Rate for Payer: Qualcare PPO/HMO/WC	$15.17
Rate for Payer: UnitedHealthcare Commercial	$20.23
Rate for Payer: UnitedHealthcare Community & State	$2.44
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

PANTOPTAZOLE 40MG TABLET EC

Facility

$67.13

Service Code	NDC 8060701
Hospital Charge Code	60629236
Hospital Revenue Code	250
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$10.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.07

PANTOPTAZOLE 40MG TABLET EC

Facility

$67.13

Service Code	NDC 8060701
Hospital Charge Code	60629236
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Commercial	$25.51
Rate for Payer: Aetna Medicare Advantage	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.12
Rate for Payer: Cigna Commercial	$33.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.14
Rate for Payer: Oxford Commercial	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.07
Rate for Payer: UnitedHealthcare Commercial	$13.43
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

PANT SCRUB REV MISTY ENCORE

Facility

$25.10

Hospital Charge Code	270658872
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.55
Rate for Payer: Aetna Commercial	$9.54
Rate for Payer: Aetna Medicare Advantage	$7.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.40
Rate for Payer: Cigna Commercial	$12.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.53
Rate for Payer: Oxford Commercial	$5.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.77
Rate for Payer: UnitedHealthcare Commercial	$5.02
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658875
Hospital Revenue Code	270
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.07
Rate for Payer: Aetna Commercial	$9.18
Rate for Payer: Aetna Medicare Advantage	$7.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.16
Rate for Payer: Cigna Commercial	$12.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658874
Hospital Revenue Code	270
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

PANT SCRUB REV MISTY ENCORE

Facility

$25.10

Hospital Charge Code	270658872
Hospital Revenue Code	270
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$3.77

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658875
Hospital Revenue Code	270
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658874
Hospital Revenue Code	270
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.07
Rate for Payer: Aetna Commercial	$9.18
Rate for Payer: Aetna Medicare Advantage	$7.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.16
Rate for Payer: Cigna Commercial	$12.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.83
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

PANT SCRUB REV MISTY ENCORE

Facility

$31.10

Hospital Charge Code	270658873
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.55
Rate for Payer: Aetna Commercial	$11.82
Rate for Payer: Aetna Medicare Advantage	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.93
Rate for Payer: Cigna Commercial	$15.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.33
Rate for Payer: Oxford Commercial	$6.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.67
Rate for Payer: UnitedHealthcare Commercial	$6.22
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

PANT SCRUB REV MISTY ENCORE

Facility

$31.10

Hospital Charge Code	270658873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.67

PAP

Facility

$142.55

Service Code	HCPCS 88141
Hospital Charge Code	3005304
Hospital Revenue Code	311
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

PAP

Facility

$142.55

Service Code	HCPCS 88141
Hospital Charge Code	3005304
Hospital Revenue Code	311
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$54.17
Rate for Payer: Aetna Medicare Advantage	$42.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.35
Rate for Payer: Cigna Commercial	$71.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$19.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

PAPAIN CHLOROPHYLLIN UREA

Facility

$185.00

Hospital Charge Code	6011043
Hospital Revenue Code	251
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

PAPAIN CHLOROPHYLLIN UREA

Facility

$185.00

Hospital Charge Code	6011043
Hospital Revenue Code	251
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

PAPAIN CHLOROPHYLLIN UREA OINT

Facility

$314.90

Hospital Charge Code	60628434
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$157.45
Rate for Payer: Aetna Commercial	$119.66
Rate for Payer: Aetna Medicare Advantage	$94.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.30
Rate for Payer: Cigna Commercial	$157.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.47
Rate for Payer: Oxford Commercial	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$47.23
Rate for Payer: UnitedHealthcare Commercial	$62.98
Rate for Payer: UnitedHealthcare Community & State	$7.59
Rate for Payer: Wellpoint Medicaid Managed Care	$8.34

PAPAIN CHLOROPHYLLIN UREA OINT

Facility

$314.90

Hospital Charge Code	60628434
Hospital Revenue Code	250
Min. Negotiated Rate	$47.23
Max. Negotiated Rate	$47.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.23

PAPAIN-UREA TOPICAL OINT

Facility

$419.25

Hospital Charge Code	60628883
Hospital Revenue Code	250
Min. Negotiated Rate	$62.89
Max. Negotiated Rate	$62.89
Rate for Payer: Qualcare PPO/HMO/WC	$62.89

PAPAIN-UREA TOPICAL OINT

Facility

$419.25

Hospital Charge Code	60628883
Hospital Revenue Code	250
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$209.62
Rate for Payer: Aetna Commercial	$159.31
Rate for Payer: Aetna Medicare Advantage	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.91
Rate for Payer: Cigna Commercial	$209.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.78
Rate for Payer: Oxford Commercial	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$62.89
Rate for Payer: UnitedHealthcare Commercial	$83.85
Rate for Payer: UnitedHealthcare Community & State	$10.10
Rate for Payer: Wellpoint Medicaid Managed Care	$11.11

PAPARELA TY 1.02 VNT TB 510041

Facility

$66.00

Hospital Charge Code	270639205
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

Know your out-of-pocket cost for care.

All Charges