Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRAMOXINE FOAM 15GM

Facility

$109.45

Hospital Charge Code	6007389
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

PRAMOXINE HCL CRM 1%

Facility

$211.25

Hospital Charge Code	60628402
Hospital Revenue Code	250
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$105.62
Rate for Payer: Aetna Commercial	$80.28
Rate for Payer: Aetna Medicare Advantage	$63.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.87
Rate for Payer: Cigna Commercial	$105.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.38
Rate for Payer: Oxford Commercial	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$31.69
Rate for Payer: UnitedHealthcare Commercial	$42.25
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.60

PRAMOXINE HCL CRM 1%

Facility

$211.25

Hospital Charge Code	60628402
Hospital Revenue Code	250
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$31.69

PRAMOXINE HCL OIN1% ZN OX12.5%

Facility

$38.45

Hospital Charge Code	60628423
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.23
Rate for Payer: Aetna Commercial	$14.61
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.80
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.54
Rate for Payer: Oxford Commercial	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$7.69
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

PRAMOXINE HCL OIN1% ZN OX12.5%

Facility

$38.45

Hospital Charge Code	60628423
Hospital Revenue Code	250
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

PRAMOXINE SOL 1%

Facility

$652.45

Service Code	NDC 37682315
Hospital Charge Code	60628421
Hospital Revenue Code	250
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$326.23
Rate for Payer: Aetna Commercial	$247.93
Rate for Payer: Aetna Medicare Advantage	$195.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.37
Rate for Payer: Cigna Commercial	$326.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.74
Rate for Payer: Oxford Commercial	$130.49
Rate for Payer: Qualcare PPO/HMO/WC	$97.87
Rate for Payer: UnitedHealthcare Commercial	$130.49
Rate for Payer: UnitedHealthcare Community & State	$15.72
Rate for Payer: Wellpoint Medicaid Managed Care	$17.29

PRAMOXINE SOL 1%

Facility

$652.45

Service Code	NDC 37682315
Hospital Charge Code	60628421
Hospital Revenue Code	250
Min. Negotiated Rate	$97.87
Max. Negotiated Rate	$97.87
Rate for Payer: Qualcare PPO/HMO/WC	$97.87

PRANDIN 1 MG

Facility

$60.43

Service Code	NDC 60846088201
Hospital Charge Code	60632257
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.06

PRANDIN 1 MG

Facility

$60.43

Service Code	NDC 60846088201
Hospital Charge Code	60632257
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$30.21
Rate for Payer: Aetna Commercial	$22.96
Rate for Payer: Aetna Medicare Advantage	$18.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$30.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.13
Rate for Payer: Oxford Commercial	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$9.06
Rate for Payer: UnitedHealthcare Commercial	$12.09
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

PRANDIN, 2MG

Facility

$2.00

Hospital Charge Code	60635445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PRANDIN, 2MG

Facility

$2.00

Hospital Charge Code	60635445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PRASUGREL 10MG TAB

Facility

$86.63

Service Code	NDC 2512377
Hospital Charge Code	60630033
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$43.31
Rate for Payer: Aetna Commercial	$32.92
Rate for Payer: Aetna Medicare Advantage	$25.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.09
Rate for Payer: Cigna Commercial	$43.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.99
Rate for Payer: Oxford Commercial	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$12.99
Rate for Payer: UnitedHealthcare Commercial	$17.33
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.30

PRASUGREL 10MG TAB

Facility

$86.63

Service Code	NDC 2512377
Hospital Charge Code	60630033
Hospital Revenue Code	250
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$12.99
Rate for Payer: Qualcare PPO/HMO/WC	$12.99

PRAVACHOL 10MG TAB BULK

Facility

$13.00

Hospital Charge Code	60635195
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

PRAVACHOL 10MG TAB BULK

Facility

$13.00

Hospital Charge Code	60635195
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PRAVACHOL 10MG TAB U/D

Facility

$8.00

Hospital Charge Code	60635194
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

PRAVACHOL 10MG TAB U/D

Facility

$8.00

Hospital Charge Code	60635194
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

PRAVACHOL/20MG/TAB

Facility

$13.00

Hospital Charge Code	60634909
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

PRAVACHOL/20MG/TAB

Facility

$13.00

Hospital Charge Code	60634909
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PRAVACHOL 20MG TAB BULK

Facility

$9.00

Hospital Charge Code	60635196
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

PRAVACHOL 20MG TAB BULK

Facility

$9.00

Hospital Charge Code	60635196
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PRAVACHOL 20MG TAB U/D

Facility

$15.00

Hospital Charge Code	60635197
Hospital Revenue Code	250
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

PRAVACHOL 20MG TAB U/D

Facility

$15.00

Hospital Charge Code	60635197
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PRAVACHOL 40MG TAB BULK

Facility

$18.00

Hospital Charge Code	60635198
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PRAVACHOL 40MG TAB BULK

Facility

$18.00

Hospital Charge Code	60635198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

Know your out-of-pocket cost for care.

All Charges