Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROPHECY REPORT

Facility

$15,480.90

Hospital Charge Code	270704976
Hospital Revenue Code	272
Min. Negotiated Rate	$373.09
Max. Negotiated Rate	$7,740.45
Rate for Payer: Aetna Commercial	$5,882.74
Rate for Payer: Aetna Medicare Advantage	$4,644.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,947.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,947.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,947.63
Rate for Payer: Cigna Commercial	$7,740.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,644.27
Rate for Payer: Oxford Commercial	$3,096.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,322.14
Rate for Payer: UnitedHealthcare Commercial	$3,096.18
Rate for Payer: UnitedHealthcare Community & State	$373.09
Rate for Payer: Wellpoint Medicaid Managed Care	$410.24

PROPHECY REPORT

Facility

$15,480.90

Hospital Charge Code	270704976
Hospital Revenue Code	272
Min. Negotiated Rate	$2,322.14
Max. Negotiated Rate	$2,322.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,322.14

PROPHYRINS,FRAC,QUAN,RAND

Facility

$101.10

Service Code	HCPCS 84120
Hospital Charge Code	39900120
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.10
Rate for Payer: Cigna Commercial	$50.55
Rate for Payer: Cigna Medicare Advantage	$14.71
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.16
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.71
Rate for Payer: Wellcare Medicare Advantage	$14.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

PROPHYRINS,FRAC,QUAN,RAND

Facility

$101.10

Service Code	HCPCS 84120
Hospital Charge Code	39900120
Hospital Revenue Code	301
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$15.16
Rate for Payer: Qualcare PPO/HMO/WC	$15.16

PROPINE 0.1% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633763
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PROPINE 0.1% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633763
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

PROPOFOL

Facility

$47.35

Hospital Charge Code	270656763
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

PROPOFOL

Facility

$47.35

Hospital Charge Code	270656763
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

PROPOFOL 10 MG/ML INJ (100 ML)

Facility

$626.05

Service Code	HCPCS J2704
Hospital Charge Code	60627671
Hospital Revenue Code	636
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$313.02
Rate for Payer: Aetna Commercial	$237.90
Rate for Payer: Aetna Medicare Advantage	$187.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.64
Rate for Payer: Cigna Commercial	$313.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.91
Rate for Payer: UnitedHealthcare Community & State	$15.09
Rate for Payer: Wellpoint Medicaid Managed Care	$16.59

PROPOFOL 10 MG/ML INJ (100 ML)

Facility

$626.05

Service Code	HCPCS J2704
Hospital Charge Code	60627671
Hospital Revenue Code	636
Min. Negotiated Rate	$93.91
Max. Negotiated Rate	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.91

PROPOFOL 10 MG/ML INJ (20 ML)

Facility

$125.02

Service Code	HCPCS J2704
Hospital Charge Code	60627672
Hospital Revenue Code	636
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

PROPOFOL 10 MG/ML INJ (20 ML)

Facility

$125.02

Service Code	HCPCS J2704
Hospital Charge Code	60627672
Hospital Revenue Code	636
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.51
Rate for Payer: Aetna Commercial	$47.51
Rate for Payer: Aetna Medicare Advantage	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

PROPOFOL 10 MG/ML INJ (50 ML)

Facility

$313.02

Service Code	HCPCS J2704
Hospital Charge Code	60627673
Hospital Revenue Code	636
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$75.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$46.95

PROPOFOL 10 MG/ML INJ (50 ML)

Facility

$313.02

Service Code	HCPCS J2704
Hospital Charge Code	60627673
Hospital Revenue Code	636
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$118.95
Rate for Payer: Aetna Medicare Advantage	$93.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.82
Rate for Payer: Cigna Commercial	$156.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$46.95
Rate for Payer: UnitedHealthcare Community & State	$7.54
Rate for Payer: Wellpoint Medicaid Managed Care	$8.30

PROPOFOL INJ 10MG 1ML 100ML

Facility

$272.65

Hospital Charge Code	6017495
Hospital Revenue Code	250
Min. Negotiated Rate	$40.90
Max. Negotiated Rate	$40.90
Rate for Payer: Qualcare PPO/HMO/WC	$40.90

PROPOFOL INJ 10MG 1ML 100ML

Facility

$272.65

Hospital Charge Code	6017495
Hospital Revenue Code	250
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$136.32
Rate for Payer: Aetna Commercial	$103.61
Rate for Payer: Aetna Medicare Advantage	$81.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.53
Rate for Payer: Cigna Commercial	$136.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.80
Rate for Payer: Oxford Commercial	$54.53
Rate for Payer: Qualcare PPO/HMO/WC	$40.90
Rate for Payer: UnitedHealthcare Commercial	$54.53
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

PROPOFOL INJ 10MG/ML 20ML

Facility

$97.30

Hospital Charge Code	6004709
Hospital Revenue Code	250
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

PROPOFOL INJ 10MG/ML 20ML

Facility

$97.30

Hospital Charge Code	6004709
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.19
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

PROPOXYPHENE 65MG

Facility

$2.45

Hospital Charge Code	6021158
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

PROPOXYPHENE 65MG

Facility

$2.45

Hospital Charge Code	6021158
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

Propoxyphene, GC/MS, Urine

Facility

$475.00

Service Code	HCPCS 80367
Hospital Charge Code	401080367
Hospital Revenue Code	301
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.46
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

Propoxyphene, GC/MS, Urine

Facility

$475.00

Service Code	HCPCS 80367
Hospital Charge Code	401080367
Hospital Revenue Code	301
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

PROPOXYPHENE NAPAP 100MG/650MG

Facility

$2.80

Hospital Charge Code	60628692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.42

PROPOXYPHENE NAPAP 100MG/650MG

Facility

$2.80

Hospital Charge Code	60628692
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna Medicare Advantage	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.71
Rate for Payer: Cigna Commercial	$1.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.84
Rate for Payer: Oxford Commercial	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.42
Rate for Payer: UnitedHealthcare Commercial	$0.56
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

PROPOXYPHENE,SERUM (DARVON)

Facility

$277.00

Service Code	HCPCS 80300
Hospital Charge Code	38473115
Hospital Revenue Code	301
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$138.50
Rate for Payer: Aetna Commercial	$105.26
Rate for Payer: Aetna Medicare Advantage	$83.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.64
Rate for Payer: Cigna Commercial	$138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.34

Know your out-of-pocket cost for care.

All Charges