Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROCAINAMIDE 1000MG/2ML INJ

Facility

$365.75

Service Code	HCPCS J2690
Hospital Charge Code	60627590
Hospital Revenue Code	636
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$775.40
Rate for Payer: Aetna Commercial	$584.28
Rate for Payer: Aetna Medicare Advantage	$695.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$775.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$775.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$214.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$775.40
Rate for Payer: Cigna Medicare Advantage	$214.81
Rate for Payer: Clover Medicare Advantage	$204.07
Rate for Payer: EmblemHealth Commercial	$644.43
Rate for Payer: Humana Medicare Advantage	$221.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$214.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.51
Rate for Payer: Qualcare PPO/HMO/WC	$54.86
Rate for Payer: UnitedHealthcare Community & State	$8.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$214.81
Rate for Payer: Wellcare Medicare Advantage	$214.81
Rate for Payer: Wellpoint Medicaid Managed Care	$9.69

PROCAINAMIDE/100MG/1ML

Facility

$53.00

Hospital Charge Code	60633732
Hospital Revenue Code	636
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

PROCAINAMIDE/100MG/1ML

Facility

$71.00

Hospital Charge Code	60633733
Hospital Revenue Code	636
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$17.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PROCAINAMIDE/100MG/1ML

Facility

$53.00

Hospital Charge Code	60633732
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$20.14
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

PROCAINAMIDE/100MG/1ML

Facility

$71.00

Hospital Charge Code	60633733
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

PROCAINAMIDE/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633728
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

PROCAINAMIDE/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROCAINAMIDE 250 MG ER TAB

Facility

$4.00

Hospital Charge Code	60627592
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

PROCAINAMIDE 250 MG ER TAB

Facility

$4.00

Hospital Charge Code	60627592
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROCAINAMIDE 375 MG CAP

Facility

$4.00

Hospital Charge Code	60627593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROCAINAMIDE 375 MG CAP

Facility

$4.00

Hospital Charge Code	60627593
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

PROCAINAMIDE/375MG/CAP

Facility

$3.00

Hospital Charge Code	60633730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROCAINAMIDE/375MG/CAP

Facility

$3.00

Hospital Charge Code	60633730
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

PROCAINAMIDE/500MG/1ML

Facility

$53.00

Hospital Charge Code	60633731
Hospital Revenue Code	636
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

PROCAINAMIDE/500MG/1ML

Facility

$53.00

Hospital Charge Code	60633731
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$20.14
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

PROCAINAMIDE/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633729
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROCAINAMIDE/500MG/CAP

Facility

$3.00

Hospital Charge Code	60633729
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

PROCAINAMIDE 500 MG ER TAB

Facility

$4.00

Hospital Charge Code	60627595
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROCAINAMIDE 500 MG ER TAB

Facility

$4.00

Hospital Charge Code	60627595
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

PROCAINAMIDE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633727
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

PROCAINAMIDE/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633727
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROCAINAMIDE CAP 250MG

Facility

$3.20

Hospital Charge Code	60627591
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

PROCAINAMIDE CAP 250MG

Facility

$3.20

Hospital Charge Code	60627591
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PROCAINAMIDE HCL 100MG/ML 10ML

Facility

$4.00

Service Code	HCPCS J2690
Hospital Charge Code	6063943312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROCAINAMIDE HCL 100MG/ML 10ML

Facility

$4.00

Service Code	HCPCS J2690
Hospital Charge Code	6063943312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$775.40
Rate for Payer: Aetna Commercial	$584.28
Rate for Payer: Aetna Medicare Advantage	$695.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$775.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$775.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$214.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$775.40
Rate for Payer: Cigna Medicare Advantage	$214.81
Rate for Payer: Clover Medicare Advantage	$204.07
Rate for Payer: EmblemHealth Commercial	$644.43
Rate for Payer: Humana Medicare Advantage	$221.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$214.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$214.81
Rate for Payer: Wellcare Medicare Advantage	$214.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges