Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRAVASTATIN 10 MG TAB

Facility

$13.50

Hospital Charge Code	60629278
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: Aetna Medicare Advantage	$4.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.44
Rate for Payer: Cigna Commercial	$6.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.05
Rate for Payer: Oxford Commercial	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

PRAVASTATIN 10 MG TAB

Facility

$13.50

Hospital Charge Code	60629278
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

PRAVASTATIN 20 MG TAB

Facility

$22.45

Hospital Charge Code	60627621
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

PRAVASTATIN 20 MG TAB

Facility

$22.45

Hospital Charge Code	60627621
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

PRAVASTATIN NA 20MG TAB UD

Facility

$20.98

Hospital Charge Code	60631959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.49
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare Advantage	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.35
Rate for Payer: Cigna Commercial	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.29
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PRAVASTATIN NA 20MG TAB UD

Facility

$20.98

Hospital Charge Code	60631959
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PRAVASTATIN SODIUM 10 MG TAB

Facility

$19.36

Service Code	NDC 904589161
Hospital Charge Code	6063943235
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

PRAVASTATIN SODIUM 10 MG TAB

Facility

$19.36

Service Code	NDC 904589161
Hospital Charge Code	6063943235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna Commercial	$7.36
Rate for Payer: Aetna Medicare Advantage	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.94
Rate for Payer: Cigna Commercial	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Oxford Commercial	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.87
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

PRAVASTATIN SODIUM 20 MG TAB

Facility

$4.00

Service Code	NDC 43063044330
Hospital Charge Code	6063943236
Hospital Revenue Code	250
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

PRAVASTATIN SODIUM 20 MG TAB

Facility

$4.00

Service Code	NDC 43063044330
Hospital Charge Code	6063943236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PRAVASTATIN SODIUM 40 MG TAB

Facility

$45.49

Service Code	NDC 3519410
Hospital Charge Code	6063943237
Hospital Revenue Code	250
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$6.82
Rate for Payer: Qualcare PPO/HMO/WC	$6.82

PRAVASTATIN SODIUM 40 MG TAB

Facility

$45.49

Service Code	NDC 3519410
Hospital Charge Code	6063943237
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.75
Rate for Payer: Aetna Commercial	$17.29
Rate for Payer: Aetna Medicare Advantage	$13.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.60
Rate for Payer: Cigna Commercial	$22.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$9.10
Rate for Payer: Qualcare PPO/HMO/WC	$6.82
Rate for Payer: UnitedHealthcare Commercial	$9.10
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

PRAZOSIN 1 MG CAP

Facility

$4.00

Hospital Charge Code	60627641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PRAZOSIN 1 MG CAP

Facility

$4.00

Hospital Charge Code	60627641
Hospital Revenue Code	250
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

PRAZOSIN 2 MG

Facility

$16.88

Service Code	NDC 51079063120
Hospital Charge Code	606390180
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

PRAZOSIN 2 MG

Facility

$16.88

Service Code	NDC 51079063120
Hospital Charge Code	606390180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.06
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

PRAZOSIN 5 MG CAP

Facility

$10.45

Hospital Charge Code	60627642
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

PRAZOSIN 5 MG CAP

Facility

$10.45

Hospital Charge Code	60627642
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PRAZOSIN 5 MG/MINIPRESS

Facility

$12.19

Service Code	NDC 51079063201
Hospital Charge Code	606390133
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

PRAZOSIN 5 MG/MINIPRESS

Facility

$12.19

Service Code	NDC 51079063201
Hospital Charge Code	606390133
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

PRAZOSIN HYDROCHLORIDE 1 MG CA

Facility

$5.03

Service Code	NDC 51079063001
Hospital Charge Code	6063943238
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PRAZOSIN HYDROCHLORIDE 1 MG CA

Facility

$5.03

Service Code	NDC 51079063001
Hospital Charge Code	6063943238
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.52
Rate for Payer: Aetna Commercial	$1.91
Rate for Payer: Aetna Medicare Advantage	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.28
Rate for Payer: Cigna Commercial	$2.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

PRCTSPY W/BCP ELCTRCAUT****

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300432
Hospital Revenue Code	361
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$42.45
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

PRCTSPY W/BCP ELCTRCAUT****

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300432
Hospital Revenue Code	361
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Medicare Advantage	$84.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.17
Rate for Payer: Cigna Commercial	$141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Community & State	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

PRDI THERAPEUTIC PHR SET****

Facility

$213.00

Hospital Charge Code	8002529
Hospital Revenue Code	279
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$31.95
Rate for Payer: Qualcare PPO/HMO/WC	$31.95

Know your out-of-pocket cost for care.

All Charges