Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PENICIL G PRO 600,000U/ML 4ML

Facility

$43.55

Hospital Charge Code	6004121
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

PENICIL G PRO 600,000U/ML 4ML

Facility

$43.55

Hospital Charge Code	6004121
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

PENICILLIN E POTAS INJ 1MU

Facility

$3.85

Hospital Charge Code	6009989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

PENICILLIN E POTAS INJ 1MU

Facility

$3.85

Hospital Charge Code	6009989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

PENICILLIN E POTAS INJ 20MU

Facility

$69.15

Hospital Charge Code	6009930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$34.58
Rate for Payer: Aetna Commercial	$26.28
Rate for Payer: Aetna Medicare Advantage	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.63
Rate for Payer: Cigna Commercial	$34.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.75
Rate for Payer: Oxford Commercial	$13.83
Rate for Payer: Qualcare PPO/HMO/WC	$10.37
Rate for Payer: UnitedHealthcare Commercial	$13.83
Rate for Payer: UnitedHealthcare Community & State	$1.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

PENICILLIN E POTAS INJ 20MU

Facility

$69.15

Hospital Charge Code	6009930
Hospital Revenue Code	250
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$10.37
Rate for Payer: Qualcare PPO/HMO/WC	$10.37

PENICILLIN G 5MU VIAL

Facility

$106.40

Service Code	HCPCS J2540
Hospital Charge Code	60627305
Hospital Revenue Code	636
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$25.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.96

PENICILLIN G 5MU VIAL

Facility

$106.40

Service Code	HCPCS J2540
Hospital Charge Code	60627305
Hospital Revenue Code	636
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$53.20
Rate for Payer: Aetna Commercial	$40.43
Rate for Payer: Aetna Medicare Advantage	$31.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.13
Rate for Payer: Cigna Commercial	$53.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.96
Rate for Payer: UnitedHealthcare Community & State	$2.56
Rate for Payer: Wellpoint Medicaid Managed Care	$2.82

PENICILLIN G BENZATHINE 1.2MU

Facility

$86.40

Hospital Charge Code	6006928
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

PENICILLIN G BENZATHINE 1.2MU

Facility

$64.00

Hospital Charge Code	6006423
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

PENICILLIN G BENZATHINE 1.2MU

Facility

$700.82

Service Code	HCPCS J0561
Hospital Charge Code	6008973
Hospital Revenue Code	636
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$169.60
Rate for Payer: Aetna Commercial	$85.60
Rate for Payer: Aetna Medicare Advantage	$101.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.60
Rate for Payer: Cigna Medicare Advantage	$31.47
Rate for Payer: Clover Medicare Advantage	$29.90
Rate for Payer: EmblemHealth Commercial	$94.41
Rate for Payer: Humana Medicare Advantage	$32.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.12
Rate for Payer: UnitedHealthcare Community & State	$16.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.47
Rate for Payer: Wellcare Medicare Advantage	$31.47
Rate for Payer: Wellpoint Medicaid Managed Care	$18.57

PENICILLIN G BENZATHINE 1.2MU

Facility

$86.40

Hospital Charge Code	6006928
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

PENICILLIN G BENZATHINE 1.2MU

Facility

$64.00

Hospital Charge Code	6006423
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PENICILLIN G BENZATHINE 1.2MU

Facility

$700.82

Service Code	HCPCS J0561
Hospital Charge Code	6008973
Hospital Revenue Code	636
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$169.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.12

PENICILLIN G BENZATHINE 2.4MU

Facility

$203.55

Hospital Charge Code	6008981
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$40.71
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$40.71
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

PENICILLIN G BENZATHINE 2.4MU

Facility

$203.55

Hospital Charge Code	6008981
Hospital Revenue Code	250
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$347.51
Rate for Payer: Aetna Commercial	$85.60
Rate for Payer: Aetna Medicare Advantage	$101.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.60
Rate for Payer: Cigna Medicare Advantage	$31.47
Rate for Payer: Clover Medicare Advantage	$29.90
Rate for Payer: EmblemHealth Commercial	$94.41
Rate for Payer: Humana Medicare Advantage	$32.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40
Rate for Payer: UnitedHealthcare Community & State	$34.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.47
Rate for Payer: Wellcare Medicare Advantage	$31.47
Rate for Payer: Wellpoint Medicaid Managed Care	$38.05

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$215.40
Max. Negotiated Rate	$347.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40

PENICILLIN G BENZAT PROC 1.2MU

Facility

$64.00

Hospital Charge Code	6006431
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

PENICILLIN G BENZAT PROC 1.2MU

Facility

$64.00

Hospital Charge Code	6006431
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PENICILLIN G INJ SODIUM 5MU

Facility

$62.10

Hospital Charge Code	6008999
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

PENICILLIN G INJ SODIUM 5MU

Facility

$62.10

Hospital Charge Code	6008999
Hospital Revenue Code	250
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

PENICILLIN G IVPB 5MU/D5W100ML

Facility

$12.80

Hospital Charge Code	60627307
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

PENICILLIN G IVPB 5MU/D5W100ML

Facility

$12.80

Hospital Charge Code	60627307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.84
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

PENICILLIN G IVPB 5MU/NS 100ML

Facility

$25.60

Hospital Charge Code	60627306
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

Know your out-of-pocket cost for care.

All Charges