Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROMETHAZINE VC W/ COD/16

Facility

$51.00

Hospital Charge Code	60634596
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

PROMETHAZINE VC W/COD SYR

Facility

$17.00

Hospital Charge Code	60634249
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

PROMETHAZINE VC W/COD SYR

Facility

$17.00

Hospital Charge Code	60634249
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

PROMETHAZINE W/CODEINE/12

Facility

$15.00

Hospital Charge Code	60633762
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PROMETHAZINE W/CODEINE/12

Facility

$15.00

Hospital Charge Code	60633762
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

PROMETHEUS ANSER IFX

Facility

$667.59

Service Code	HCPCS 83520
Hospital Charge Code	397080006
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PROMETHEUS ANSER IFX

Facility

$667.59

Service Code	HCPCS 83520
Hospital Charge Code	397080006
Hospital Revenue Code	306
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PROMETHEUS ANSER IFX

Facility

$340.81

Hospital Charge Code	397073689
Hospital Revenue Code	306
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$51.12
Rate for Payer: Qualcare PPO/HMO/WC	$51.12

PROMETHEUS ANSER IFX

Facility

$340.81

Hospital Charge Code	397073689
Hospital Revenue Code	306
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$170.41
Rate for Payer: Aetna Commercial	$129.51
Rate for Payer: Aetna Medicare Advantage	$102.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.91
Rate for Payer: Cigna Commercial	$170.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.21
Rate for Payer: Wellpoint Medicaid Managed Care	$9.03

PROMETHZINE DM12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635688
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

PROMETHZINE DM12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635688
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PROMOD

Facility

$21.00

Hospital Charge Code	60634859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PROMOD

Facility

$21.00

Hospital Charge Code	60634859
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PROPAFENONE 150 MG TAB

Facility

$21.17

Service Code	NDC 173079220
Hospital Charge Code	60628853
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.18

PROPAFENONE 150 MG TAB

Facility

$21.17

Service Code	NDC 173079220
Hospital Charge Code	60628853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.59
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.40
Rate for Payer: Cigna Commercial	$10.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.35
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.18
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PROPAFENONE HCL 225 MG TAB

Facility

$15.61

Service Code	NDC 591058301
Hospital Charge Code	606390056
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Commercial	$5.93
Rate for Payer: Aetna Medicare Advantage	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.98
Rate for Payer: Cigna Commercial	$7.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.68
Rate for Payer: Oxford Commercial	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.34
Rate for Payer: UnitedHealthcare Commercial	$3.12
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

PROPAFENONE HCL 225 MG TAB

Facility

$15.61

Service Code	NDC 591058301
Hospital Charge Code	606390056
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$2.34

PROPANOLOL TAB 10MG

Facility

$1.95

Hospital Charge Code	6022800
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PROPANOLOL TAB 10MG

Facility

$1.95

Hospital Charge Code	6022800
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PROPANTHELINE 7.5 MG TAB

Facility

$5.65

Hospital Charge Code	60627438
Hospital Revenue Code	252
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

PROPANTHELINE 7.5 MG TAB

Facility

$5.65

Hospital Charge Code	60627438
Hospital Revenue Code	252
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

PROPHECY ALIGNMENT GUIDE SET

Facility

$2,500.00

Hospital Charge Code	270697650
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

PROPHECY ALIGNMENT GUIDE SET

Facility

$2,500.00

Hospital Charge Code	270697650
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

PROPHECY INFINITY SET

Facility

$6,095.00

Hospital Charge Code	270676383
Hospital Revenue Code	272
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

PROPHECY INFINITY SET

Facility

$6,095.00

Hospital Charge Code	270676383
Hospital Revenue Code	272
Min. Negotiated Rate	$146.89
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,828.50
Rate for Payer: Oxford Commercial	$1,219.00
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Commercial	$1,219.00
Rate for Payer: UnitedHealthcare Community & State	$146.89
Rate for Payer: Wellpoint Medicaid Managed Care	$161.52

Know your out-of-pocket cost for care.

All Charges