Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008646
Hospital Revenue Code	301
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$28.82
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008647
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008646
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008647
Hospital Revenue Code	301
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$28.82
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
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	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
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	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH CAPSULE/BRAVO SYSTEM

Facility

$1,125.00

Hospital Charge Code	270656806
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

PH CAPSULE/BRAVO SYSTEM

Facility

$1,125.00

Hospital Charge Code	270656806
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

PH CONT STRIPS 6.0-8.0 12VIALS

Facility

$7.55

Hospital Charge Code	270652775
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.13

PH CONT STRIPS 6.0-8.0 12VIALS

Facility

$7.55

Hospital Charge Code	270652775
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.77
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.93
Rate for Payer: Cigna Commercial	$3.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.27
Rate for Payer: Oxford Commercial	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.13
Rate for Payer: UnitedHealthcare Commercial	$1.51
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.04
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$9.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Commercial	$3.62
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

PHENCYCLIDINE PCP, SERUM

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3007648
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PHENCYCLIDINE PCP, SERUM

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3007648
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

PHENCYCLIDINE PCP, URINE

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3008224
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

PHENCYCLIDINE PCP, URINE

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3008224
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$203.68
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.92
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

PHENELZINE 15 MG TAB

Facility

$5.63

Service Code	NDC 43386036021
Hospital Charge Code	606390055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

Know your out-of-pocket cost for care.

All Charges