Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PAXIL 12.5MG TAB

Facility

$37.39

Service Code	NDC 60505367303
Hospital Charge Code	60635469
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

PAXIL 25MG TAB

Facility

$38.99

Service Code	NDC 378200493
Hospital Charge Code	60635470
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

PAXIL 25MG TAB

Facility

$38.99

Service Code	NDC 378200493
Hospital Charge Code	60635470
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.94
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

PAXIL 30MG TAB

Facility

$8.00

Hospital Charge Code	60635278
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

PAXIL 30MG TAB

Facility

$8.00

Hospital Charge Code	60635278
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

PAXIL 37.5 MG TAB

Facility

$62.78

Service Code	NDC 60505367003
Hospital Charge Code	60635471
Hospital Revenue Code	250
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$9.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.42

PAXIL 37.5 MG TAB

Facility

$62.78

Service Code	NDC 60505367003
Hospital Charge Code	60635471
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.39
Rate for Payer: Aetna Commercial	$23.86
Rate for Payer: Aetna Medicare Advantage	$18.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.01
Rate for Payer: Cigna Commercial	$31.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.83
Rate for Payer: Oxford Commercial	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$9.42
Rate for Payer: UnitedHealthcare Commercial	$12.56
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

PAXLOVID TABLETS 300MG 100MG D

Facility

$1,167.81

Service Code	NDC 69532103
Hospital Charge Code	6063943397
Hospital Revenue Code	250
Min. Negotiated Rate	$28.14
Max. Negotiated Rate	$583.90
Rate for Payer: Aetna Commercial	$443.77
Rate for Payer: Aetna Medicare Advantage	$350.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$297.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$297.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$297.79
Rate for Payer: Cigna Commercial	$583.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.34
Rate for Payer: Oxford Commercial	$233.56
Rate for Payer: Qualcare PPO/HMO/WC	$175.17
Rate for Payer: UnitedHealthcare Commercial	$233.56
Rate for Payer: UnitedHealthcare Community & State	$28.14
Rate for Payer: Wellpoint Medicaid Managed Care	$30.95

PAXLOVID TABLETS 300MG 100MG D

Facility

$1,167.81

Service Code	NDC 69532103
Hospital Charge Code	6063943397
Hospital Revenue Code	250
Min. Negotiated Rate	$175.17
Max. Negotiated Rate	$175.17
Rate for Payer: Qualcare PPO/HMO/WC	$175.17

PCB POLYCHLORINATED BIPHENY***

Facility

$103.00

Hospital Charge Code	3032679
Hospital Revenue Code	309
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

PCB POLYCHLORINATED BIPHENY***

Facility

$103.00

Hospital Charge Code	3032679
Hospital Revenue Code	309
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

PC C5E 10FT A/B 8C

Facility

$25.00

Hospital Charge Code	270659103
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

PC C5E 10FT A/B 8C

Facility

$25.00

Hospital Charge Code	270659103
Hospital Revenue Code	270
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PC C5E 3FT BLK A/B 8C

Facility

$11.25

Hospital Charge Code	270659104
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PC C5E 3FT BLK A/B 8C

Facility

$11.25

Hospital Charge Code	270659104
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

PC C5E 3FT BLUE A/B 8C

Facility

$11.25

Hospital Charge Code	270659101
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PC C5E 3FT BLUE A/B 8C

Facility

$11.25

Hospital Charge Code	270659101
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

PC C5E 5FT BLUE A/B 8C

Facility

$15.00

Hospital Charge Code	270659102
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

PC C5E 5FT BLUE A/B 8C

Facility

$15.00

Hospital Charge Code	270659102
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PCEEA 25 28 31****

Facility

$875.00

Hospital Charge Code	1600956
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

PCEEA 25 28 31****

Facility

$875.00

Hospital Charge Code	1600956
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

PCK CSTM GYN LAP AVIBMBM009-08

Facility

$194.95

Hospital Charge Code	270642268
Hospital Revenue Code	272
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$29.24
Rate for Payer: Qualcare PPO/HMO/WC	$29.24

PCK CSTM GYN LAP AVIBMBM009-08

Facility

$194.95

Hospital Charge Code	270642268
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.47
Rate for Payer: Aetna Commercial	$74.08
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.71
Rate for Payer: Cigna Commercial	$97.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.48
Rate for Payer: Oxford Commercial	$38.99
Rate for Payer: Qualcare PPO/HMO/WC	$29.24
Rate for Payer: UnitedHealthcare Commercial	$38.99
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

PCMKR EXT MEDT BIF DUAL 749851

Facility

$4,014.45

Hospital Charge Code	270611256
Hospital Revenue Code	275
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$2,007.22
Rate for Payer: Aetna Commercial	$1,525.49
Rate for Payer: Aetna Medicare Advantage	$1,204.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$802.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.68
Rate for Payer: Cigna Commercial	$2,007.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$883.18
Rate for Payer: Qualcare PPO/HMO/WC	$602.17
Rate for Payer: UnitedHealthcare Community & State	$96.75
Rate for Payer: Wellpoint Medicaid Managed Care	$106.38

PCMKR EXT MEDT BIF DUAL 749851

Facility

$4,014.45

Hospital Charge Code	270611256
Hospital Revenue Code	275
Min. Negotiated Rate	$602.17
Max. Negotiated Rate	$971.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$802.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$883.18
Rate for Payer: Qualcare PPO/HMO/WC	$602.17

Know your out-of-pocket cost for care.

All Charges