Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROPOXYPHENE,SERUM (DARVON)

Facility

$277.00

Service Code	HCPCS 80300
Hospital Charge Code	38473115
Hospital Revenue Code	301
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

PROPRANOLOL 10 MG TAB

Facility

$4.00

Service Code	NDC 51079027720
Hospital Charge Code	60627597
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

PROPRANOLOL 10 MG TAB

Facility

$4.00

Service Code	NDC 51079027720
Hospital Charge Code	60627597
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROPRANOLOL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROPRANOLOL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633764
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

PROPRANOLOL 120 MG ER CAP

Facility

$203.14

Service Code	NDC 24090047388
Hospital Charge Code	60627598
Hospital Revenue Code	250
Min. Negotiated Rate	$30.47
Max. Negotiated Rate	$30.47
Rate for Payer: Qualcare PPO/HMO/WC	$30.47

PROPRANOLOL 120 MG ER CAP

Facility

$203.14

Service Code	NDC 24090047388
Hospital Charge Code	60627598
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$101.57
Rate for Payer: Aetna Commercial	$77.19
Rate for Payer: Aetna Medicare Advantage	$60.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.80
Rate for Payer: Cigna Commercial	$101.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.94
Rate for Payer: Oxford Commercial	$40.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.47
Rate for Payer: UnitedHealthcare Commercial	$40.63
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$5.38

PROPRANOLOL 1 MG/ML INJ

Facility

$67.00

Service Code	HCPCS J1800
Hospital Charge Code	60627599
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

PROPRANOLOL 1 MG/ML INJ

Facility

$67.00

Service Code	HCPCS J1800
Hospital Charge Code	60627599
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

PROPRANOLOL 20 MG TAB

Facility

$4.00

Service Code	NDC 50111046801
Hospital Charge Code	60627600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROPRANOLOL 20 MG TAB

Facility

$4.00

Service Code	NDC 50111046801
Hospital Charge Code	60627600
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

PROPRANOLOL 40 MG TAB

Facility

$4.82

Service Code	NDC 23155011201
Hospital Charge Code	60627601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

PROPRANOLOL 40 MG TAB

Facility

$4.82

Service Code	NDC 23155011201
Hospital Charge Code	60627601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare Advantage	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.23
Rate for Payer: Cigna Commercial	$2.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$0.96
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

PROPRANOLOL 60 MG ER CAP

Facility

$14.61

Service Code	NDC 68084050301
Hospital Charge Code	60627602
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

PROPRANOLOL 60 MG ER CAP

Facility

$14.61

Service Code	NDC 68084050301
Hospital Charge Code	60627602
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

PROPRANOLOL 80 MG ER CAP

Facility

$168.84

Service Code	NDC 24090047188
Hospital Charge Code	60627603
Hospital Revenue Code	250
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$25.33
Rate for Payer: Qualcare PPO/HMO/WC	$25.33

PROPRANOLOL 80 MG ER CAP

Facility

$168.84

Service Code	NDC 24090047188
Hospital Charge Code	60627603
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$84.42
Rate for Payer: Aetna Commercial	$64.16
Rate for Payer: Aetna Medicare Advantage	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.05
Rate for Payer: Cigna Commercial	$84.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.65
Rate for Payer: Oxford Commercial	$33.77
Rate for Payer: Qualcare PPO/HMO/WC	$25.33
Rate for Payer: UnitedHealthcare Commercial	$33.77
Rate for Payer: UnitedHealthcare Community & State	$4.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

PROPRANOLOL (INDERAL)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472569
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

PROPRANOLOL (INDERAL)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472569
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

PROPRANOLOL INJ 1MG

Facility

$34.60

Hospital Charge Code	6009054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

PROPRANOLOL INJ 1MG

Facility

$34.60

Hospital Charge Code	6009054
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PROPRANOLOL TAB 80MG

Facility

$4.50

Hospital Charge Code	60627604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

PROPRANOLOL TAB 80MG

Facility

$4.50

Hospital Charge Code	60627604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

PROPRANOLOL VL 1MG/ML

Facility

$10.90

Hospital Charge Code	6009559
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

PROPRANOLOL VL 1MG/ML

Facility

$10.90

Hospital Charge Code	6009559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

Know your out-of-pocket cost for care.

All Charges