Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PYRIDIUM/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633790
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDIUM/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDIUM/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PYRIDIUM/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633791
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDIUM/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633791
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PYRIDIUM COLLAGEN (TOT&LINKED)

Facility

$92.85

Service Code	HCPCS 82523
Hospital Charge Code	3000718
Hospital Revenue Code	301
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.81
Rate for Payer: Aetna Medicare Advantage	$60.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.43
Rate for Payer: Cigna Commercial	$46.42
Rate for Payer: Cigna Medicare Advantage	$18.68
Rate for Payer: Clover Medicare Advantage	$17.75
Rate for Payer: EmblemHealth Commercial	$56.04
Rate for Payer: Humana Medicare Advantage	$19.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.68
Rate for Payer: Wellcare Medicare Advantage	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

PYRIDIUM COLLAGEN (TOT&LINKED)

Facility

$92.85

Service Code	HCPCS 82523
Hospital Charge Code	3000718
Hospital Revenue Code	301
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$13.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.93

PYRIDOSTIGMINE 180 MG ER TAB

Facility

$152.36

Service Code	NDC 187301330
Hospital Charge Code	60629837
Hospital Revenue Code	250
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$22.85
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

PYRIDOSTIGMINE 180 MG ER TAB

Facility

$152.36

Service Code	NDC 187301330
Hospital Charge Code	60629837
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$76.18
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$76.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.71
Rate for Payer: Oxford Commercial	$30.47
Rate for Payer: Qualcare PPO/HMO/WC	$22.85
Rate for Payer: UnitedHealthcare Commercial	$30.47
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

PYRIDOSTIGMINE 60 MG TAB

Facility

$80.33

Service Code	NDC 187301030
Hospital Charge Code	60627416
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$12.05
Rate for Payer: Qualcare PPO/HMO/WC	$12.05

PYRIDOSTIGMINE 60 MG TAB

Facility

$80.33

Service Code	NDC 187301030
Hospital Charge Code	60627416
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.16
Rate for Payer: Aetna Commercial	$30.53
Rate for Payer: Aetna Medicare Advantage	$24.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.48
Rate for Payer: Cigna Commercial	$40.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.10
Rate for Payer: Oxford Commercial	$16.07
Rate for Payer: Qualcare PPO/HMO/WC	$12.05
Rate for Payer: UnitedHealthcare Commercial	$16.07
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

PYRIDOXINE/100MG/1ML/VIAL

Facility

$75.31

Service Code	HCPCS J3415
Hospital Charge Code	60634979
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.66
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$37.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.30
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

PYRIDOXINE/100MG/1ML/VIAL

Facility

$75.31

Service Code	HCPCS J3415
Hospital Charge Code	60634979
Hospital Revenue Code	636
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.30

PYRIDOXINE/100MG/TAB

Facility

$4.00

Service Code	NDC 904051860
Hospital Charge Code	60633793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDOXINE/100MG/TAB

Facility

$4.00

Service Code	NDC 904051860
Hospital Charge Code	60633793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PYRIDOXINE 25MG TABLET

Facility

$4.00

Service Code	NDC 61748009201
Hospital Charge Code	60632254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDOXINE 25MG TABLET

Facility

$4.00

Service Code	NDC 61748009201
Hospital Charge Code	60632254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PYRIDOXINE 50 MG TAB

Facility

$4.00

Service Code	NDC 904052060
Hospital Charge Code	60628486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PYRIDOXINE 50 MG TAB

Facility

$4.00

Service Code	NDC 904052060
Hospital Charge Code	60628486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDOXINE/50MG/TAB

Facility

$1.00

Hospital Charge Code	60633792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

PYRIDOXINE/50MG/TAB

Facility

$1.00

Hospital Charge Code	60633792
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PYRIDOXINE INJ 100MG

Facility

$10.90

Hospital Charge Code	6009062
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

PYRIDOXINE INJ 100MG

Facility

$10.90

Hospital Charge Code	6009062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

PYRIDOXINE INJ 100MG/1ML

Facility

$16.00

Hospital Charge Code	60629036
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

PYRIDOXINE INJ 100MG/1ML

Facility

$16.00

Hospital Charge Code	60629036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

Know your out-of-pocket cost for care.

All Charges