Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROSTIGMIN 1:4000/1ML

Facility

$6.00

Hospital Charge Code	60633769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROSTIGMIN 1:4000/1ML

Facility

$6.00

Hospital Charge Code	60633769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270656819
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270656819
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$424.23
Max. Negotiated Rate	$424.23
Rate for Payer: Qualcare PPO/HMO/WC	$424.23

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,414.10
Rate for Payer: Aetna Commercial	$1,074.72
Rate for Payer: Aetna Medicare Advantage	$848.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$721.19
Rate for Payer: Cigna Commercial	$1,414.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$848.46
Rate for Payer: Oxford Commercial	$565.64
Rate for Payer: Qualcare PPO/HMO/WC	$424.23
Rate for Payer: UnitedHealthcare Commercial	$565.64
Rate for Payer: UnitedHealthcare Community & State	$68.16
Rate for Payer: Wellpoint Medicaid Managed Care	$74.95

PROSTIN E2 2MG VAG SUPP

Facility

$122.00

Hospital Charge Code	60634779
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

PROSTIN E2 2MG VAG SUPP

Facility

$122.00

Hospital Charge Code	60634779
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$662.11
Rate for Payer: Aetna Commercial	$503.20
Rate for Payer: Aetna Medicare Advantage	$397.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.68
Rate for Payer: Cigna Commercial	$662.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.27
Rate for Payer: Oxford Commercial	$264.84
Rate for Payer: Qualcare PPO/HMO/WC	$198.63
Rate for Payer: UnitedHealthcare Commercial	$264.84
Rate for Payer: UnitedHealthcare Community & State	$31.91
Rate for Payer: Wellpoint Medicaid Managed Care	$35.09

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$198.63
Max. Negotiated Rate	$198.63
Rate for Payer: Qualcare PPO/HMO/WC	$198.63

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$129.90
Max. Negotiated Rate	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$129.90

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$433.00
Rate for Payer: Aetna Commercial	$329.08
Rate for Payer: Aetna Medicare Advantage	$259.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.83
Rate for Payer: Cigna Commercial	$433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.80
Rate for Payer: Oxford Commercial	$173.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.90
Rate for Payer: UnitedHealthcare Commercial	$173.20
Rate for Payer: UnitedHealthcare Community & State	$20.87
Rate for Payer: Wellpoint Medicaid Managed Care	$22.95

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
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

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
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

PROTAMINE SULFATE***

Facility

$163.00

Hospital Charge Code	3032497
Hospital Revenue Code	309
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.94
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

PROTAMINE SULFATE***

Facility

$163.00

Hospital Charge Code	3032497
Hospital Revenue Code	309
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PROTAMINE SULFATE/10MG/1M

Facility

$24.00

Hospital Charge Code	60633771
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$5.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633770
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULFATE/10MG/1M

Facility

$24.00

Hospital Charge Code	60633771
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633772
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633770
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633772
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

PROTAMINE SULF VL 50MG

Facility

$9.00

Hospital Charge Code	6013171
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

Know your out-of-pocket cost for care.

All Charges