Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROTONIX IV 40MG

Facility

$57.60

Hospital Charge Code	60635761
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna Commercial	$21.89
Rate for Payer: Aetna Medicare Advantage	$17.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.69
Rate for Payer: Cigna Commercial	$28.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.28
Rate for Payer: Oxford Commercial	$11.52
Rate for Payer: Qualcare PPO/HMO/WC	$8.64
Rate for Payer: UnitedHealthcare Commercial	$11.52
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

PROTRACTOR ENDO MED 100201

Facility

$729.65

Hospital Charge Code	270609589
Hospital Revenue Code	272
Min. Negotiated Rate	$109.45
Max. Negotiated Rate	$109.45
Rate for Payer: Qualcare PPO/HMO/WC	$109.45

PROTRACTOR ENDO MED 100201

Facility

$729.65

Hospital Charge Code	270609589
Hospital Revenue Code	272
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$364.82
Rate for Payer: Aetna Commercial	$277.27
Rate for Payer: Aetna Medicare Advantage	$218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.06
Rate for Payer: Cigna Commercial	$364.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.90
Rate for Payer: Oxford Commercial	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$109.45
Rate for Payer: UnitedHealthcare Commercial	$145.93
Rate for Payer: UnitedHealthcare Community & State	$17.58
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

PROTRACTOR ENDO SM 100101

Facility

$729.65

Hospital Charge Code	270609588
Hospital Revenue Code	272
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$364.82
Rate for Payer: Aetna Commercial	$277.27
Rate for Payer: Aetna Medicare Advantage	$218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.06
Rate for Payer: Cigna Commercial	$364.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.90
Rate for Payer: Oxford Commercial	$145.93
Rate for Payer: Qualcare PPO/HMO/WC	$109.45
Rate for Payer: UnitedHealthcare Commercial	$145.93
Rate for Payer: UnitedHealthcare Community & State	$17.58
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

PROTRACTOR ENDO SM 100101

Facility

$729.65

Hospital Charge Code	270609588
Hospital Revenue Code	272
Min. Negotiated Rate	$109.45
Max. Negotiated Rate	$109.45
Rate for Payer: Qualcare PPO/HMO/WC	$109.45

PROVAY BLUE 0.5% 10MG/ML 10 ML

Facility

$1,867.02

Service Code	HCPCS Q9968
Hospital Charge Code	606390266
Hospital Revenue Code	636
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$451.82
Rate for Payer: Aetna Commercial	$27.99
Rate for Payer: Aetna Medicare Advantage	$33.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.14
Rate for Payer: Cigna Medicare Advantage	$10.29
Rate for Payer: Clover Medicare Advantage	$9.78
Rate for Payer: EmblemHealth Commercial	$30.87
Rate for Payer: Humana Medicare Advantage	$10.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.82
Rate for Payer: Qualcare PPO/HMO/WC	$280.05
Rate for Payer: UnitedHealthcare Community & State	$45.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.29
Rate for Payer: Wellcare Medicare Advantage	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$49.48

PROVAY BLUE 0.5% 10MG/ML 10 ML

Facility

$1,867.02

Service Code	HCPCS Q9968
Hospital Charge Code	606390266
Hospital Revenue Code	636
Min. Negotiated Rate	$280.05
Max. Negotiated Rate	$451.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.82
Rate for Payer: Qualcare PPO/HMO/WC	$280.05

PROVENDA AMNIOTIC MEMBR 3X3CM

Facility

$13,180.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694280
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,189.56
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.00
Rate for Payer: UnitedHealthcare Community & State	$317.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$349.27

PROVENDA AMNIOTIC MEMBR 3X3CM

Facility

$13,180.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694280
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.00
Max. Negotiated Rate	$3,189.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,899.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.00

PROVENTIL/0.83MG/1ML

Facility

$3.00

Hospital Charge Code	60633776
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROVENTIL/0.83MG/1ML

Facility

$3.00

Hospital Charge Code	60633776
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

PROVENTIL/17GM

Facility

$118.00

Hospital Charge Code	60633773
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

PROVENTIL/17GM

Facility

$118.00

Hospital Charge Code	60633773
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

PROVENTIL/2MG/TAB

Facility

$39.40

Service Code	NDC 53489017601
Hospital Charge Code	60633774
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.70
Rate for Payer: Aetna Commercial	$14.97
Rate for Payer: Aetna Medicare Advantage	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.05
Rate for Payer: Cigna Commercial	$19.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.91
Rate for Payer: UnitedHealthcare Commercial	$7.88
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

PROVENTIL/2MG/TAB

Facility

$39.40

Service Code	NDC 53489017601
Hospital Charge Code	60633774
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.91

PROVENTIL/4MG/TAB

Facility

$47.24

Service Code	NDC 51079065820
Hospital Charge Code	60633775
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

PROVENTIL/4MG/TAB

Facility

$47.24

Service Code	NDC 51079065820
Hospital Charge Code	60633775
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

PROVENTIL HFA INHALER

Facility

$80.00

Hospital Charge Code	60635214
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

PROVENTIL HFA INHALER

Facility

$80.00

Hospital Charge Code	60635214
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

PROVENTIL LIQUID/16OZ

Facility

$152.00

Hospital Charge Code	60634592
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

PROVENTIL LIQUID/16OZ

Facility

$152.00

Hospital Charge Code	60634592
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

PROVENTIL REPETABS

Facility

$6.00

Hospital Charge Code	60634862
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

PROVENTIL REPETABS

Facility

$6.00

Hospital Charge Code	60634862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROVENTIL REPETABS U/D

Facility

$6.00

Hospital Charge Code	60634861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROVENTIL REPETABS U/D

Facility

$6.00

Hospital Charge Code	60634861
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

Know your out-of-pocket cost for care.

All Charges