Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PROPHECY ALIGNMENT GUIDE SET

Facility

$2,500.00

Hospital Charge Code	270697650
Hospital Revenue Code	272
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

PROPHECY ALIGNMENT GUIDE SET

Facility

$2,500.00

Hospital Charge Code	270697650
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

PROPHECY INFINITY SET

Facility

$6,095.00

Hospital Charge Code	270676383
Hospital Revenue Code	272
Min. Negotiated Rate	$173.10
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,584.70
Rate for Payer: Oxford Commercial	$1,219.00
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Commercial	$1,219.00
Rate for Payer: UnitedHealthcare Community & State	$192.60
Rate for Payer: Wellpoint Medicaid Managed Care	$173.10

PROPHECY INFINITY SET

Facility

$6,095.00

Hospital Charge Code	270676383
Hospital Revenue Code	272
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

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

PROPHECY REPORT

Facility

$15,480.90

Hospital Charge Code	270704976
Hospital Revenue Code	272
Min. Negotiated Rate	$439.66
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	$4,025.03
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	$489.20
Rate for Payer: Wellpoint Medicaid Managed Care	$439.66

PROPHYRINS,FRAC,QUAN,RAND

Facility

$101.10

Service Code	HCPCS 84120
Hospital Charge Code	39900120
Hospital Revenue Code	301
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$156.00
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	$53.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.36
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	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.36
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	$26.29
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.16
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$2.87

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

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	$17.78
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	$19.78
Rate for Payer: Wellpoint Medicaid Managed Care	$17.78

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	$3.55
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	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

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	$8.89
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	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$8.89

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, GC/MS, Urine

Facility

$475.00

Service Code	HCPCS 80367
Hospital Charge Code	401080367
Hospital Revenue Code	301
Min. Negotiated Rate	$13.49
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	$123.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.46
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

PROPOXYPHENE,SERUM (DARVON)

Facility

$277.00

Service Code	HCPCS 80300
Hospital Charge Code	38473115
Hospital Revenue Code	301
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$156.00
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	$72.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

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	$0.11
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	$1.04
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	$0.13
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 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	$5.77
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	$52.82
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	$6.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

PROPRANOLOL 1 MG/ML INJ

Facility

$67.00

Service Code	HCPCS J1800
Hospital Charge Code	60627599
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
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	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

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 20 MG TAB

Facility

$4.00

Service Code	NDC 50111046801
Hospital Charge Code	60627600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges