Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PENICILLIN G IVPB 5MU/NS 100ML

Facility

$25.60

Hospital Charge Code	60627306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

PENICILLIN G POTAS INJ 5MU

Facility

$142.75

Hospital Charge Code	6004097
Hospital Revenue Code	250
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

PENICILLIN G POTAS INJ 5MU

Facility

$142.75

Hospital Charge Code	6004097
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.83
Rate for Payer: Oxford Commercial	$28.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$28.55
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

PENICILLIN G POTAS INJ 5MU

Facility

$25.60

Hospital Charge Code	6009955
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

PENICILLIN G POTAS INJ 5MU

Facility

$25.60

Hospital Charge Code	6009955
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

PENICILLIN G PRO300,000U/ML10M

Facility

$203.55

Hospital Charge Code	6004105
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 PRO300,000U/ML10M

Facility

$203.55

Hospital Charge Code	6004105
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 PROC IM 0.6MU/1ML

Facility

$19.85

Hospital Charge Code	60627308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

PENICILLIN G PROC IM 0.6MU/1ML

Facility

$19.85

Hospital Charge Code	60627308
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PENICILLIN G PROC IM 1.2MU/2ML

Facility

$19.25

Hospital Charge Code	60627309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

PENICILLIN G PROC IM 1.2MU/2ML

Facility

$19.25

Hospital Charge Code	60627309
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.51

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.71
Rate for Payer: Aetna Commercial	$8.90
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.97
Rate for Payer: Cigna Commercial	$11.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.03
Rate for Payer: Oxford Commercial	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$3.51
Rate for Payer: UnitedHealthcare Commercial	$4.68
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$37.38
Rate for Payer: Aetna Commercial	$28.41
Rate for Payer: Aetna Medicare Advantage	$22.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.07
Rate for Payer: Cigna Commercial	$37.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.43
Rate for Payer: Oxford Commercial	$14.95
Rate for Payer: Qualcare PPO/HMO/WC	$11.22
Rate for Payer: UnitedHealthcare Commercial	$14.95
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$11.22

PENICILLIN VK TAB 250MG

Facility

$1.95

Hospital Charge Code	6022719
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PENICILLIN VK TAB 250MG

Facility

$1.95

Hospital Charge Code	6022719
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.74
Rate for Payer: Aetna Commercial	$11.20
Rate for Payer: Aetna Medicare Advantage	$8.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.52
Rate for Payer: Cigna Commercial	$14.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$5.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.42
Rate for Payer: UnitedHealthcare Commercial	$5.90
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.42

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$0.92
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

PENICILLIN V POTAS TAB 500MG

Facility

$4.00

Hospital Charge Code	60627313
Hospital Revenue Code	251
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

PENICILLIN V POTAS TAB 500MG

Facility

$4.00

Hospital Charge Code	60627313
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PENICIL PHEN SUSP 250MG/5ML

Facility

$21.15

Hospital Charge Code	6004139
Hospital Revenue Code	251
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

PENICIL PHEN SUSP 250MG/5ML

Facility

$21.15

Hospital Charge Code	6004139
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

Know your out-of-pocket cost for care.

All Charges