Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERMETHRIN 1% CREME N GEL KIT

Facility

$70.28

Service Code	NDC 363095526
Hospital Charge Code	606350998
Hospital Revenue Code	250
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$10.54
Rate for Payer: Qualcare PPO/HMO/WC	$10.54

PERMETHRIN 1% CREME N GEL KIT

Facility

$70.28

Service Code	NDC 363095526
Hospital Charge Code	606350998
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.14
Rate for Payer: Aetna Commercial	$26.71
Rate for Payer: Aetna Medicare Advantage	$21.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.92
Rate for Payer: Cigna Commercial	$35.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.08
Rate for Payer: Oxford Commercial	$14.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.54
Rate for Payer: UnitedHealthcare Commercial	$14.06
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

PERMETHRIN 1% LOTION

Facility

$36.00

Hospital Charge Code	60635675
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

PERMETHRIN 1% LOTION

Facility

$36.00

Hospital Charge Code	60635675
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

PERMETHRIN 5 % CRE

Facility

$795.96

Service Code	NDC 45802026937
Hospital Charge Code	6010342
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$397.98
Rate for Payer: Aetna Commercial	$302.46
Rate for Payer: Aetna Medicare Advantage	$238.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.97
Rate for Payer: Cigna Commercial	$397.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.79
Rate for Payer: Oxford Commercial	$159.19
Rate for Payer: Qualcare PPO/HMO/WC	$119.39
Rate for Payer: UnitedHealthcare Commercial	$159.19
Rate for Payer: UnitedHealthcare Community & State	$19.18
Rate for Payer: Wellpoint Medicaid Managed Care	$21.09

PERMETHRIN 5 % CRE

Facility

$795.96

Service Code	NDC 45802026937
Hospital Charge Code	6010342
Hospital Revenue Code	250
Min. Negotiated Rate	$119.39
Max. Negotiated Rate	$119.39
Rate for Payer: Qualcare PPO/HMO/WC	$119.39

PERM PACEMAKER ATRIA

Facility

$57,852.45

Service Code	HCPCS 33206
Hospital Charge Code	7411009
Hospital Revenue Code	480
Min. Negotiated Rate	$793.76
Max. Negotiated Rate	$47,726.04
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,355.74
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,677.87
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$1,394.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$47,726.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,533.09

PERM PACEMAKER ATRIA

Facility

$57,852.45

Service Code	HCPCS 33206
Hospital Charge Code	366833206
Hospital Revenue Code	480
Min. Negotiated Rate	$793.76
Max. Negotiated Rate	$47,726.04
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,355.74
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,677.87
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$1,394.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$47,726.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,533.09

PERM PACEMAKER ATRIA

Facility

$57,852.45

Service Code	HCPCS 33206
Hospital Charge Code	366833206
Hospital Revenue Code	480
Min. Negotiated Rate	$8,677.87
Max. Negotiated Rate	$8,677.87
Rate for Payer: Qualcare PPO/HMO/WC	$8,677.87

PERM PACEMAKER ATRIA

Facility

$57,852.45

Service Code	HCPCS 33206
Hospital Charge Code	7411009
Hospital Revenue Code	480
Min. Negotiated Rate	$8,677.87
Max. Negotiated Rate	$8,677.87
Rate for Payer: Qualcare PPO/HMO/WC	$8,677.87

PERM PACEMAKER DUAL

Facility

$39,837.00

Service Code	HCPCS 33208
Hospital Charge Code	366833208
Hospital Revenue Code	480
Min. Negotiated Rate	$565.91
Max. Negotiated Rate	$44,822.55
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,951.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$960.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,055.68

PERM PACEMAKER DUAL

Facility

$39,837.00

Service Code	HCPCS 33208
Hospital Charge Code	366833208
Hospital Revenue Code	480
Min. Negotiated Rate	$5,975.55
Max. Negotiated Rate	$5,975.55
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55

PERM PACEMAKER DUAL

Facility

$39,837.00

Service Code	HCPCS 33208
Hospital Charge Code	7411013
Hospital Revenue Code	481
Min. Negotiated Rate	$5,975.55
Max. Negotiated Rate	$5,975.55
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55

PERM PACEMAKER DUAL

Facility

$39,837.00

Service Code	HCPCS 33208
Hospital Charge Code	7411013
Hospital Revenue Code	481
Min. Negotiated Rate	$960.07
Max. Negotiated Rate	$44,822.55
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,951.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55
Rate for Payer: UnitedHealthcare Commercial	$17,313.00
Rate for Payer: UnitedHealthcare Community & State	$960.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,055.68

PERM PACEMAKER VENT

Facility

$32,811.00

Service Code	HCPCS 33207
Hospital Charge Code	366833207
Hospital Revenue Code	480
Min. Negotiated Rate	$790.75
Max. Negotiated Rate	$44,822.55
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,843.30
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,921.65
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$790.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04
Rate for Payer: Wellpoint Medicaid Managed Care	$869.49

PERM PACEMAKER VENT

Facility

$32,811.00

Service Code	HCPCS 33207
Hospital Charge Code	7411011
Hospital Revenue Code	480
Min. Negotiated Rate	$4,921.65
Max. Negotiated Rate	$4,921.65
Rate for Payer: Qualcare PPO/HMO/WC	$4,921.65

PERM PACEMAKER VENT

Facility

$32,811.00

Service Code	HCPCS 33207
Hospital Charge Code	366833207
Hospital Revenue Code	480
Min. Negotiated Rate	$4,921.65
Max. Negotiated Rate	$4,921.65
Rate for Payer: Qualcare PPO/HMO/WC	$4,921.65

PERM PACEMAKER VENT

Facility

$32,811.00

Service Code	HCPCS 33207
Hospital Charge Code	7411011
Hospital Revenue Code	480
Min. Negotiated Rate	$790.75
Max. Negotiated Rate	$44,822.55
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,843.30
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,921.65
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$790.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04
Rate for Payer: Wellpoint Medicaid Managed Care	$869.49

PEROXIDASE STAIN

Facility

$363.25

Service Code	HCPCS 88319
Hospital Charge Code	3030038
Hospital Revenue Code	310
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$54.49
Rate for Payer: Qualcare PPO/HMO/WC	$54.49

PEROXIDASE STAIN

Facility

$363.25

Service Code	HCPCS 88319
Hospital Charge Code	3030038
Hospital Revenue Code	310
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.49
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$111.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$9.63

PERPHENAZIN-AMITRIPTYLIN

Facility

$3.00

Hospital Charge Code	60633639
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

PERPHENAZIN-AMITRIPTYLIN

Facility

$3.00

Hospital Charge Code	60633638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERPHENAZIN-AMITRIPTYLIN

Facility

$3.00

Hospital Charge Code	60633638
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

PERPHENAZIN-AMITRIPTYLIN

Facility

$3.00

Hospital Charge Code	60633639
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERPHENAZINE 2 MG TAB

Facility

$13.13

Service Code	HCPCS Q0175
Hospital Charge Code	60627814
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

Know your out-of-pocket cost for care.

All Charges