Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

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

Facility

$47.35

Hospital Charge Code	270656763
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$14.21
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	$6.16
Rate for Payer: Oxford Commercial	$23.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$23.68

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	$0.09
Max. Negotiated Rate	$187.81
Rate for Payer: Aetna Commercial	$187.81
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	$0.09
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 (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	$0.09
Max. Negotiated Rate	$37.51
Rate for Payer: Aetna Commercial	$37.51
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	$0.09
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	$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 (50 ML)

Facility

$313.02

Service Code	HCPCS J2704
Hospital Charge Code	60627673
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$93.91
Rate for Payer: Aetna Commercial	$93.91
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	$0.09
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	$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 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	$35.44
Max. Negotiated Rate	$136.32
Rate for Payer: Aetna Commercial	$81.80
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	$35.44
Rate for Payer: Oxford Commercial	$136.32
Rate for Payer: Qualcare PPO/HMO/WC	$40.90
Rate for Payer: UnitedHealthcare Commercial	$136.32

PROPOFOL INJ 10MG/ML 20ML

Facility

$97.30

Hospital Charge Code	6004709
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$29.19
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	$12.65
Rate for Payer: Oxford Commercial	$48.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$48.65

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

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 65MG

Facility

$2.45

Hospital Charge Code	6021158
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
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	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

Propoxyphene, GC/MS, Urine

Facility

$475.00

Service Code	HCPCS 80367
Hospital Charge Code	401080367
Hospital Revenue Code	301
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
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	$61.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$0.36
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$0.84
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	$0.36
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.42
Rate for Payer: UnitedHealthcare Commercial	$1.40

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

PROPOXYPHENE,SERUM (DARVON)

Facility

$277.00

Service Code	HCPCS 80300
Hospital Charge Code	38473115
Hospital Revenue Code	301
Min. Negotiated Rate	$36.01
Max. Negotiated Rate	$138.50
Rate for Payer: Aetna Commercial	$83.10
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	$36.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$114.00

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 10 MG TAB

Facility

$4.00

Service Code	NDC 51079027720
Hospital Charge Code	60627597
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PROPRANOLOL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

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

Know your out-of-pocket cost for care.

All Charges