Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROCELLERA DRESSING 1.5X 10

Facility

$187.50

Hospital Charge Code	270332707
Hospital Revenue Code	272
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$93.75
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare Advantage	$56.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.81
Rate for Payer: Cigna Commercial	$93.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.25
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.12
Rate for Payer: UnitedHealthcare Commercial	$37.50
Rate for Payer: UnitedHealthcare Community & State	$4.52
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

PROCELLERA DRESSING 1.5X10

Facility

$187.50

Hospital Charge Code	270332709
Hospital Revenue Code	272
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$28.12
Rate for Payer: Qualcare PPO/HMO/WC	$28.12

PROCELLERA DRESSING 1.5X10

Facility

$187.50

Hospital Charge Code	270332709
Hospital Revenue Code	272
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$93.75
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare Advantage	$56.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.81
Rate for Payer: Cigna Commercial	$93.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.25
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.12
Rate for Payer: UnitedHealthcare Commercial	$37.50
Rate for Payer: UnitedHealthcare Community & State	$4.52
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

PROCELLERA RX 12 X12

Facility

$1,800.00

Hospital Charge Code	270658375
Hospital Revenue Code	278
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

PROCELLERA RX 12 X12

Facility

$1,800.00

Hospital Charge Code	270658375
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

PROCELLERA RX 1.5 X 8

Facility

$150.00

Hospital Charge Code	27065872
Hospital Revenue Code	271
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PROCELLERA RX 1.5 X 8

Facility

$150.00

Hospital Charge Code	27065872
Hospital Revenue Code	271
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

pROCELLERA RX 1 X 1

Facility

$12.50

Hospital Charge Code	270658366
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.75
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.50
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

pROCELLERA RX 1 X 1

Facility

$12.50

Hospital Charge Code	270658366
Hospital Revenue Code	270
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

PROCELLERA RX 1 X5

Facility

$50.00

Hospital Charge Code	270658368
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PROCELLERA RX 1 X5

Facility

$62.50

Hospital Charge Code	270658367
Hospital Revenue Code	270
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

PROCELLERA RX 1 X5

Facility

$50.00

Hospital Charge Code	270658368
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

PROCELLERA RX 1 X5

Facility

$62.50

Hospital Charge Code	270658367
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$12.50
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

PROCHLORPERAZINE 10MG/2 ML INJ

Facility

$72.36

Service Code	HCPCS J0780
Hospital Charge Code	60628148
Hospital Revenue Code	636
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$17.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

PROCHLORPERAZINE 10MG/2 ML INJ

Facility

$72.36

Service Code	HCPCS J0780
Hospital Charge Code	60628148
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.18
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.45
Rate for Payer: Cigna Commercial	$36.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

PROCHLORPERAZINE 10 MG ER CAP

Facility

$10.45

Hospital Charge Code	6008122
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

PROCHLORPERAZINE 10 MG ER CAP

Facility

$10.45

Hospital Charge Code	6008122
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PROCHLORPERAZINE 10 MG UD

Facility

$6.50

Service Code	NDC 51079054220
Hospital Charge Code	60632734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

PROCHLORPERAZINE 10 MG UD

Facility

$6.50

Service Code	NDC 51079054220
Hospital Charge Code	60632734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

PROCHLORPERAZINE 25 MG SUPP

Facility

$82.14

Service Code	HCPCS Q0164
Hospital Charge Code	60628147
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.07
Rate for Payer: Aetna Commercial	$31.21
Rate for Payer: Aetna Medicare Advantage	$24.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.95
Rate for Payer: Cigna Commercial	$41.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$12.32
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

PROCHLORPERAZINE 25 MG SUPP

Facility

$82.14

Service Code	HCPCS Q0164
Hospital Charge Code	60628147
Hospital Revenue Code	636
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$19.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$12.32

PROCHLORPERAZINE 5MG ORAL

Facility

$7.00

Hospital Charge Code	60632733
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PROCHLORPERAZINE 5MG ORAL

Facility

$7.00

Hospital Charge Code	60632733
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PROCHLORPERAZINE 5 MG TAB

Facility

$4.09

Service Code	HCPCS J8597
Hospital Charge Code	60629225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

PROCHLORPERAZINE 5 MG TAB

Facility

$4.09

Service Code	HCPCS J8597
Hospital Charge Code	60629225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.04
Rate for Payer: Aetna Commercial	$1.55
Rate for Payer: Aetna Medicare Advantage	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.04
Rate for Payer: Cigna Commercial	$2.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.61
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges