Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROTHROMBIN GENE ANALYSIS

Facility

$390.00

Service Code	HCPCS 81240
Hospital Charge Code	39900016
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$237.12
Rate for Payer: Aetna Commercial	$178.68
Rate for Payer: Aetna Medicare Advantage	$212.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$65.69
Rate for Payer: Clover Medicare Advantage	$62.41
Rate for Payer: EmblemHealth Commercial	$197.07
Rate for Payer: Humana Medicare Advantage	$67.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$65.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$52.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.69
Rate for Payer: Wellcare Medicare Advantage	$65.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PROTHROMBIN GENE ANALYSIS

Facility

$390.00

Service Code	HCPCS 81240
Hospital Charge Code	39900016
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROTHROMBIN GENE ANALYSIS

Facility

$111.00

Hospital Charge Code	3002286A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

PROTHROMBIN GENE ANALYSIS

Facility

$111.00

Hospital Charge Code	3002286A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

PROTHROMBIN TIME (PT)

Facility

$176.40

Service Code	HCPCS 85610
Hospital Charge Code	38478008
Hospital Revenue Code	305
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$26.46
Rate for Payer: Qualcare PPO/HMO/WC	$26.46

PROTHROMBIN TIME (PT)

Facility

$176.40

Service Code	HCPCS 85610
Hospital Charge Code	38478008
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$88.20
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$4.67

PROTHROMB ISOLAT EXTRAC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479507
Hospital Revenue Code	301
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

PROTHROMB ISOLAT EXTRAC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479507
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

PROTHRO MOLECULAR DIAG & INTER

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479509
Hospital Revenue Code	301
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

PROTHRO MOLECULAR DIAG & INTER

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479509
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

PROTIEN S,TOTAL

Facility

$410.00

Service Code	HCPCS 85305
Hospital Charge Code	38479111
Hospital Revenue Code	305
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

PROTIEN S,TOTAL

Facility

$410.00

Service Code	HCPCS 85305
Hospital Charge Code	38479111
Hospital Revenue Code	305
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$37.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.91
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$11.61
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Medicare Advantage	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

PROTIME (PT)

Facility

$661.89

Service Code	HCPCS 85610
Hospital Charge Code	3002284
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$330.94
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$330.94
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$17.54

PROTIME (PT)

Facility

$661.89

Service Code	HCPCS 85610
Hospital Charge Code	3002284
Hospital Revenue Code	305
Min. Negotiated Rate	$99.28
Max. Negotiated Rate	$99.28
Rate for Payer: Qualcare PPO/HMO/WC	$99.28

PROTIRELIN AMP 500MG/ML

Facility

$30.10

Hospital Charge Code	6007587
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PROTIRELIN AMP 500MG/ML

Facility

$30.10

Hospital Charge Code	6007587
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

PROTOE SIZE SMALL

Facility

$3,440.00

Hospital Charge Code	270663473
Hospital Revenue Code	270
Min. Negotiated Rate	$82.90
Max. Negotiated Rate	$1,720.00
Rate for Payer: Aetna Commercial	$1,307.20
Rate for Payer: Aetna Medicare Advantage	$1,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$877.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$877.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$877.20
Rate for Payer: Cigna Commercial	$1,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,032.00
Rate for Payer: Oxford Commercial	$688.00
Rate for Payer: Qualcare PPO/HMO/WC	$516.00
Rate for Payer: UnitedHealthcare Commercial	$688.00
Rate for Payer: UnitedHealthcare Community & State	$82.90
Rate for Payer: Wellpoint Medicaid Managed Care	$91.16

PROTOE SIZE SMALL

Facility

$3,440.00

Hospital Charge Code	270663473
Hospital Revenue Code	270
Min. Negotiated Rate	$516.00
Max. Negotiated Rate	$516.00
Rate for Payer: Qualcare PPO/HMO/WC	$516.00

PRO-TOE VO INSTRUMENT KIT

Facility

$1,300.00

Hospital Charge Code	270663199
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

PRO-TOE VO INSTRUMENT KIT

Facility

$1,300.00

Hospital Charge Code	270663199
Hospital Revenue Code	270
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

PROTONIX 40MG SUSP.

Facility

$67.13

Service Code	NDC 8084402
Hospital Charge Code	60635725
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Commercial	$25.51
Rate for Payer: Aetna Medicare Advantage	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.12
Rate for Payer: Cigna Commercial	$33.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.14
Rate for Payer: Oxford Commercial	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.07
Rate for Payer: UnitedHealthcare Commercial	$13.43
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

PROTONIX 40MG SUSP.

Facility

$67.13

Service Code	NDC 8084402
Hospital Charge Code	60635725
Hospital Revenue Code	250
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$10.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.07

PROTONIX 40MG TAB

Facility

$23.00

Hospital Charge Code	60635726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

PROTONIX 40MG TAB

Facility

$23.00

Hospital Charge Code	60635726
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTONIX IV 40MG

Facility

$57.60

Hospital Charge Code	60635761
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Qualcare PPO/HMO/WC	$8.64

Know your out-of-pocket cost for care.

All Charges