Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRO-PREDICTRX METABOLITES

Facility

$124.10

Service Code	HCPCS 82542
Hospital Charge Code	39900060
Hospital Revenue Code	301
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$62.05
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

PRO-PREDICTRX METABOLITES

Facility

$124.10

Service Code	HCPCS 82542
Hospital Charge Code	39900060
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

PROPRNLOL 160 ER INDERL 160 LA

Facility

$13.10

Hospital Charge Code	6000386
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

PROPRNLOL 160 ER INDERL 160 LA

Facility

$13.10

Hospital Charge Code	6000386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.55
Rate for Payer: Aetna Commercial	$4.98
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.34
Rate for Payer: Cigna Commercial	$6.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.93
Rate for Payer: Oxford Commercial	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.62
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

PROPULSID/10MG/TAB

Facility

$4.00

Hospital Charge Code	60634911
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

PROPULSID/10MG/TAB

Facility

$4.00

Hospital Charge Code	60634911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROPULSID/20MG

Facility

$5.00

Hospital Charge Code	60634969
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PROPULSID/20MG

Facility

$5.00

Hospital Charge Code	60634969
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

PROPYLTHIOURACIL 50 MG TAB

Facility

$6.03

Service Code	NDC 480924201
Hospital Charge Code	60628266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PROPYLTHIOURACIL 50 MG TAB

Facility

$6.03

Service Code	NDC 480924201
Hospital Charge Code	60628266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROPYLTHIOURACIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633766
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

PROPYLTHIOURACIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633765
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

PROPYLTHIOURACIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633765
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROPYLTHIOURACIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633766
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROQUAD 0.5ML VIAL

Facility

$1,217.46

Service Code	HCPCS 90710
Hospital Charge Code	83652587
Hospital Revenue Code	636
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$608.73
Rate for Payer: Aetna Commercial	$462.63
Rate for Payer: Aetna Medicare Advantage	$365.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.45
Rate for Payer: Cigna Commercial	$608.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.63
Rate for Payer: Qualcare PPO/HMO/WC	$182.62
Rate for Payer: UnitedHealthcare Community & State	$29.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.26

PROQUAD 0.5ML VIAL

Facility

$1,217.46

Service Code	HCPCS 90710
Hospital Charge Code	83652587
Hospital Revenue Code	636
Min. Negotiated Rate	$182.62
Max. Negotiated Rate	$294.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.63
Rate for Payer: Qualcare PPO/HMO/WC	$182.62

PROSHEATINTRO4FR11CM0.035X50RE

Facility

$46.50

Hospital Charge Code	2709006379
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PROSHEATINTRO4FR11CM0.035X50RE

Facility

$46.50

Hospital Charge Code	2709006379
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO6FR11CM0.035X50GR

Facility

$46.50

Hospital Charge Code	2709006381
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PROSHEATINTRO6FR11CM0.035X50GR

Facility

$46.50

Hospital Charge Code	2709006381
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO7FR11CM0.035X50OR

Facility

$46.50

Hospital Charge Code	2709006382
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.95
Rate for Payer: Oxford Commercial	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.30
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PROSHEATINTRO7FR11CM0.035X50OR

Facility

$46.50

Hospital Charge Code	2709006382
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO8FR11CM0.035X50BL

Facility

$47.50

Hospital Charge Code	2709006383
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

PROSHEATINTRO8FR11CM0.035X50BL

Facility

$47.50

Hospital Charge Code	2709006383
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

PROSHIELD PLUS SPRAY

Facility

$49.85

Service Code	NDC 64015008
Hospital Charge Code	6063943165
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$24.93
Rate for Payer: Aetna Commercial	$18.94
Rate for Payer: Aetna Medicare Advantage	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.71
Rate for Payer: Cigna Commercial	$24.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.96
Rate for Payer: Oxford Commercial	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$7.48
Rate for Payer: UnitedHealthcare Commercial	$9.97
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

Know your out-of-pocket cost for care.

All Charges