Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL INJ 30MG/ML

Facility

$14.75

Hospital Charge Code	6011183
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

PHENOBARBITAL INJ TUB 130MG/ML

Facility

$17.95

Hospital Charge Code	6016000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PHENOBARBITAL INJ TUB 130MG/ML

Facility

$17.95

Hospital Charge Code	6016000
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

PHENOBARBITAL LQ 20MG/5ML

Facility

$6.50

Service Code	NDC 603150858
Hospital Charge Code	6023386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

PHENOBARBITAL LQ 20MG/5ML

Facility

$6.50

Service Code	NDC 603150858
Hospital Charge Code	6023386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

PHENOBARBITAL,SERUM

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39900006
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHENOBARBITAL,SERUM

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39900006
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
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	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PHENOBARBITAL SODIUM/130M

Facility

$15.00

Hospital Charge Code	60633655
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PHENOBARBITAL SODIUM/130M

Facility

$15.00

Hospital Charge Code	60633655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

PHENOBARBITAL SODIUM/30MG

Facility

$9.00

Hospital Charge Code	60633656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

PHENOBARBITAL SODIUM/30MG

Facility

$9.00

Hospital Charge Code	60633656
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PHENOBARBITAL SYRG 130MG/1ML

Facility

$333.86

Service Code	HCPCS J2560
Hospital Charge Code	60627737
Hospital Revenue Code	636
Min. Negotiated Rate	$50.08
Max. Negotiated Rate	$80.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.79
Rate for Payer: Qualcare PPO/HMO/WC	$50.08

PHENOBARBITAL SYRG 130MG/1ML

Facility

$333.86

Service Code	HCPCS J2560
Hospital Charge Code	60627737
Hospital Revenue Code	636
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$166.93
Rate for Payer: Aetna Commercial	$126.87
Rate for Payer: Aetna Medicare Advantage	$100.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.13
Rate for Payer: Cigna Commercial	$166.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.79
Rate for Payer: Qualcare PPO/HMO/WC	$50.08
Rate for Payer: UnitedHealthcare Community & State	$8.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.85

PHENOBARB LIQ 4MG/ML 4 OZ

Facility

$90.90

Hospital Charge Code	6004188
Hospital Revenue Code	251
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

PHENOBARB LIQ 4MG/ML 4 OZ

Facility

$90.90

Hospital Charge Code	6004188
Hospital Revenue Code	251
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.27
Rate for Payer: Oxford Commercial	$18.18
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$18.18
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

PHENOL 1.4% THROAT SPRAY

Facility

$19.97

Service Code	NDC 536242558
Hospital Charge Code	60628681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.98
Rate for Payer: Aetna Commercial	$7.59
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.09
Rate for Payer: Cigna Commercial	$9.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Oxford Commercial	$3.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$3.99
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

PHENOL 1.4% THROAT SPRAY

Facility

$19.97

Service Code	NDC 536242558
Hospital Charge Code	60628681
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

PHENOL EZ SWABS

Facility

$38.12

Service Code	NDC 884629730
Hospital Charge Code	6063943230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.06
Rate for Payer: Aetna Commercial	$14.49
Rate for Payer: Aetna Medicare Advantage	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.72
Rate for Payer: Cigna Commercial	$19.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$7.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$7.62
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

PHENOL EZ SWABS

Facility

$38.12

Service Code	NDC 884629730
Hospital Charge Code	6063943230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.72

PHENO/LOZENGE

Facility

$1.95

Hospital Charge Code	6024160
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENO/LOZENGE

Facility

$1.95

Hospital Charge Code	6024160
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

PHENOLPHTHALEIN, STOOL

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3035116A
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

PHENOLPHTHALEIN, STOOL

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3035116B
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

PHENOLPHTHALEIN, STOOL

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3035116A
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

PHENOLPHTHALEIN, STOOL

Facility

$246.45

Service Code	HCPCS 84999
Hospital Charge Code	3035116B
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

Know your out-of-pocket cost for care.

All Charges