Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROCHLORPERAZINE EDISYLAT

Facility

$18.00

Hospital Charge Code	60633745
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

PROCHLORPERAZINE EDISYLAT

Facility

$18.00

Hospital Charge Code	60633745
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PROCHLORPERAZINE INJ 10MG/2ML*

Facility

$1.84

Service Code	HCPCS J0780
Hospital Charge Code	60628148P
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.70
Rate for Payer: Aetna Medicare Advantage	$0.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.47
Rate for Payer: Cigna Commercial	$0.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.28
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PROCHLORPERAZINE INJ 10MG/2ML*

Facility

$1.84

Service Code	HCPCS J0780
Hospital Charge Code	60628148P
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.28

PROCHLORPERAZINE TAB 5MG

Facility

$4.50

Hospital Charge Code	6014161
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

PROCHLORPERAZINE TAB 5MG

Facility

$4.50

Hospital Charge Code	6014161
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

PROCISE MAX PLASMA WAND

Facility

$1,250.00

Hospital Charge Code	270655896
Hospital Revenue Code	271
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

PROCISE MAX PLASMA WAND

Facility

$1,250.00

Hospital Charge Code	270655896
Hospital Revenue Code	271
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.65
Max. Negotiated Rate	$60,470.00
Rate for Payer: Aetna Commercial	$45,957.20
Rate for Payer: Aetna Medicare Advantage	$36,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,839.70
Rate for Payer: Cigna Commercial	$60,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26,606.80
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00
Rate for Payer: UnitedHealthcare Community & State	$2,914.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3,204.91

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$18,141.00
Max. Negotiated Rate	$29,267.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26,606.80
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$243.41
Max. Negotiated Rate	$5,050.00
Rate for Payer: Aetna Commercial	$3,838.00
Rate for Payer: Aetna Medicare Advantage	$3,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,575.50
Rate for Payer: Cigna Commercial	$5,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$3,433.68
Max. Negotiated Rate	$3,433.68
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$551.68
Max. Negotiated Rate	$11,445.60
Rate for Payer: Aetna Commercial	$8,698.66
Rate for Payer: Aetna Medicare Advantage	$6,867.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,837.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,837.26
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	$5,837.26
Rate for Payer: Cigna Commercial	$11,445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,867.36
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$551.68
Rate for Payer: Wellpoint Medicaid Managed Care	$606.62

PROCTOCORT 1%/30GM

Facility

$80.00

Hospital Charge Code	60633746
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

PROCTOCORT 1%/30GM

Facility

$80.00

Hospital Charge Code	60633746
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

PROCTOSCOPY***

Facility

$190.00

Service Code	HCPCS 45300
Hospital Charge Code	2300408
Hospital Revenue Code	759
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PROCTOSCOPY***

Facility

$190.00

Service Code	HCPCS 45300
Hospital Charge Code	2300408
Hospital Revenue Code	759
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$3,988.03
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.03
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

PROCTOSCOPY W/ANAL DILATAT***

Facility

$221.00

Service Code	HCPCS 99999
Hospital Charge Code	2300440
Hospital Revenue Code	759
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

PROCTOSCOPY W/ANAL DILATAT***

Facility

$221.00

Service Code	HCPCS 99999
Hospital Charge Code	2300440
Hospital Revenue Code	759
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

PROCTOSCOPY WITH IRC***

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300416
Hospital Revenue Code	759
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$141.50
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) 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

PROCTOSCOPY WITH IRC***

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300416
Hospital Revenue Code	759
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$42.45
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

PROCTOSCOPY W/POLYPECTOMY***

Facility

$331.00

Service Code	HCPCS 99999
Hospital Charge Code	2300424
Hospital Revenue Code	361
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$49.65

PROCTOSCOPY W/POLYPECTOMY***

Facility

$331.00

Service Code	HCPCS 99999
Hospital Charge Code	2300424
Hospital Revenue Code	361
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$125.78
Rate for Payer: Aetna Medicare Advantage	$99.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.41
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	$84.41
Rate for Payer: Cigna Commercial	$165.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.30
Rate for Payer: Qualcare PPO/HMO/WC	$49.65
Rate for Payer: UnitedHealthcare Community & State	$7.98
Rate for Payer: Wellpoint Medicaid Managed Care	$8.77

PROCTOSGMDOSCP RIGID W/DECMP**

Facility

$909.00

Hospital Charge Code	2300017
Hospital Revenue Code	759
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna Commercial	$345.42
Rate for Payer: Aetna Medicare Advantage	$272.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.79
Rate for Payer: Cigna Commercial	$454.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.70
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: Wellpoint Medicaid Managed Care	$24.09

Know your out-of-pocket cost for care.

All Charges