Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROLIXIN/2.5MG/TAB

Facility

$9.00

Hospital Charge Code	60633750
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROLIXIN/2.5MG/TAB

Facility

$9.00

Hospital Charge Code	60633750
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

PROLIXIN/5MG/TAB

Facility

$9.00

Hospital Charge Code	60633749
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

PROLIXIN/5MG/TAB

Facility

$9.00

Hospital Charge Code	60633749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROLIXIN DECANOATE/25MG/1

Facility

$383.00

Hospital Charge Code	60633754
Hospital Revenue Code	250
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

PROLIXIN DECANOATE/25MG/1

Facility

$383.00

Hospital Charge Code	60633754
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$145.54
Rate for Payer: Aetna Medicare Advantage	$114.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.67
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.90
Rate for Payer: Oxford Commercial	$76.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
Rate for Payer: UnitedHealthcare Commercial	$76.60
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

PROLIXIN ENANTHATE/25MG/1

Facility

$565.00

Hospital Charge Code	60633755
Hospital Revenue Code	250
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$84.75
Rate for Payer: Qualcare PPO/HMO/WC	$84.75

PROLIXIN ENANTHATE/25MG/1

Facility

$565.00

Hospital Charge Code	60633755
Hospital Revenue Code	250
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$282.50
Rate for Payer: Aetna Commercial	$214.70
Rate for Payer: Aetna Medicare Advantage	$169.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.07
Rate for Payer: Cigna Commercial	$282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.50
Rate for Payer: Oxford Commercial	$113.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.75
Rate for Payer: UnitedHealthcare Commercial	$113.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: Wellpoint Medicaid Managed Care	$14.97

PROLIXIN HCL INJ/10ML

Facility

$235.00

Hospital Charge Code	60634804
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

PROLIXIN HCL INJ/10ML

Facility

$235.00

Hospital Charge Code	60634804
Hospital Revenue Code	250
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

PROLIXIN LIQ CONC/120ML

Facility

$473.00

Hospital Charge Code	60634615
Hospital Revenue Code	250
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$70.95
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

PROLIXIN LIQ CONC/120ML

Facility

$473.00

Hospital Charge Code	60634615
Hospital Revenue Code	250
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$236.50
Rate for Payer: Aetna Commercial	$179.74
Rate for Payer: Aetna Medicare Advantage	$141.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.61
Rate for Payer: Cigna Commercial	$236.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.90
Rate for Payer: Oxford Commercial	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$70.95
Rate for Payer: UnitedHealthcare Commercial	$94.60
Rate for Payer: UnitedHealthcare Community & State	$11.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.53

PROLOID/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633756
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

PROLOID/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$143.50
Rate for Payer: Aetna Commercial	$109.06
Rate for Payer: Aetna Medicare Advantage	$86.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.19
Rate for Payer: Cigna Commercial	$143.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.05
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: Wellpoint Medicaid Managed Care	$7.61

PROLONGED VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99213WF
Hospital Charge Code	9600014
Hospital Revenue Code	519
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$9.61
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

PROLONGED VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99213WF
Hospital Charge Code	9600014
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$378.33
Rate for Payer: Aetna Commercial	$287.53
Rate for Payer: Aetna Medicare Advantage	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.95
Rate for Payer: Cigna Commercial	$378.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.00
Rate for Payer: Oxford Commercial	$151.33
Rate for Payer: Qualcare PPO/HMO/WC	$113.50
Rate for Payer: UnitedHealthcare Commercial	$151.33
Rate for Payer: UnitedHealthcare Community & State	$18.24
Rate for Payer: Wellpoint Medicaid Managed Care	$20.05

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$113.50
Rate for Payer: Qualcare PPO/HMO/WC	$113.50

PROMETHAZINE 12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PROMETHAZINE 12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635690
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

PROMETHAZINE 12.5 MG SUPP

Facility

$118.66

Service Code	NDC 713053612
Hospital Charge Code	60627859
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$59.33
Rate for Payer: Aetna Commercial	$45.09
Rate for Payer: Aetna Medicare Advantage	$35.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.26
Rate for Payer: Cigna Commercial	$59.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.60
Rate for Payer: Oxford Commercial	$23.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$23.73
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.14

Know your out-of-pocket cost for care.

All Charges