Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PENTAZOCINE NALOXN TAB 50-.5MG

Facility

$10.45

Hospital Charge Code	60627723
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PENTAZOCINE NALOXN TAB 50-.5MG

Facility

$10.45

Hospital Charge Code	60627723
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

PENTAZOCINE SYR 30MG/1ML

Facility

$13.65

Hospital Charge Code	60627722
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

PENTAZOCINE SYR 30MG/1ML

Facility

$13.65

Hospital Charge Code	60627722
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

PENTIDS 800/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PENTIDS 800/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633623
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

PENTOBARBITAL 50 MG/ML INJ

Facility

$128.00

Hospital Charge Code	60628771
Hospital Revenue Code	250
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PENTOBARBITAL 50 MG/ML INJ

Facility

$128.00

Hospital Charge Code	60628771
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

PENTOBARBITAL INJ 50MG/1ML

Facility

$102.40

Hospital Charge Code	60628752
Hospital Revenue Code	250
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$15.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.36

PENTOBARBITAL INJ 50MG/1ML

Facility

$102.40

Hospital Charge Code	60628752
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$30.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.11
Rate for Payer: Cigna Commercial	$51.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.72
Rate for Payer: Oxford Commercial	$20.48
Rate for Payer: Qualcare PPO/HMO/WC	$15.36
Rate for Payer: UnitedHealthcare Commercial	$20.48
Rate for Payer: UnitedHealthcare Community & State	$2.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.71

PENTOBARBITAL (NEMBUTAL)

Facility

$159.25

Service Code	HCPCS 80345
Hospital Charge Code	3004638
Hospital Revenue Code	301
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$23.89
Rate for Payer: Qualcare PPO/HMO/WC	$23.89

PENTOBARBITAL (NEMBUTAL)

Facility

$159.25

Service Code	HCPCS 80345
Hospital Charge Code	3004638
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$60.52
Rate for Payer: Aetna Medicare Advantage	$47.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.61
Rate for Payer: Cigna Commercial	$79.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.22

PENTOBARB SOD INJ 50MG/ML 2ML

Facility

$61.45

Hospital Charge Code	6004154
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$23.35
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$12.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$12.29
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

PENTOBARB SOD INJ 50MG/ML 2ML

Facility

$61.45

Hospital Charge Code	6004154
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

PENTOBARB SOD SUPP 120MG

Facility

$19.85

Hospital Charge Code	6004162
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

PENTOBARB SOD SUPP 120MG

Facility

$19.85

Hospital Charge Code	6004162
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PENTOSTATIN 10MG

Facility

$6,524.20

Hospital Charge Code	6007017
Hospital Revenue Code	636
Min. Negotiated Rate	$157.23
Max. Negotiated Rate	$3,262.10
Rate for Payer: Aetna Commercial	$2,479.20
Rate for Payer: Aetna Medicare Advantage	$1,957.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.67
Rate for Payer: Cigna Commercial	$3,262.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.86
Rate for Payer: Qualcare PPO/HMO/WC	$978.63
Rate for Payer: UnitedHealthcare Community & State	$157.23
Rate for Payer: Wellpoint Medicaid Managed Care	$172.89

PENTOSTATIN 10MG

Facility

$6,524.20

Hospital Charge Code	6007017
Hospital Revenue Code	636
Min. Negotiated Rate	$978.63
Max. Negotiated Rate	$1,578.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.86
Rate for Payer: Qualcare PPO/HMO/WC	$978.63

PENTOTHAL 500MG VIAL

Facility

$92.00

Hospital Charge Code	60635633
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PENTOTHAL 500MG VIAL

Facility

$92.00

Hospital Charge Code	60635633
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.60
Rate for Payer: Oxford Commercial	$18.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$18.40
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

PENTOTHAL INJ/1GM

Facility

$63.00

Hospital Charge Code	60634945
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$12.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.67

PENTOTHAL INJ/1GM

Facility

$63.00

Hospital Charge Code	60634945
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

PENTOTHAL SODIUM 400MG/20 ML

Facility

$34.60

Hospital Charge Code	6007710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

PENTOTHAL SODIUM 400MG/20 ML

Facility

$34.60

Hospital Charge Code	6007710
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PENTOXIFYLLINE 400 MG ER TAB

Facility

$10.05

Service Code	NDC 51079088920
Hospital Charge Code	60627537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.02
Rate for Payer: Oxford Commercial	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$2.01
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

Know your out-of-pocket cost for care.

All Charges