Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHENOL TOPICAL 99% LIQ

Facility

$153.65

Hospital Charge Code	60628784
Hospital Revenue Code	250
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

PHENOL TOPICAL 99% LIQ

Facility

$153.65

Hospital Charge Code	60628784
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$30.73
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

PHENOL TOPICAL - LIQ

Facility

$71.45

Hospital Charge Code	60628452
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.73
Rate for Payer: Aetna Commercial	$27.15
Rate for Payer: Aetna Medicare Advantage	$21.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.22
Rate for Payer: Cigna Commercial	$35.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.43
Rate for Payer: Oxford Commercial	$14.29
Rate for Payer: Qualcare PPO/HMO/WC	$10.72
Rate for Payer: UnitedHealthcare Commercial	$14.29
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

PHENOL TOPICAL - LIQ

Facility

$71.45

Hospital Charge Code	60628452
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

PHENOTHIAZINES

Facility

$318.00

Service Code	HCPCS 80342
Hospital Charge Code	38473100
Hospital Revenue Code	301
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

PHENOTHIAZINES

Facility

$318.00

Service Code	HCPCS 80342
Hospital Charge Code	38473100
Hospital Revenue Code	301
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

PHENOTYPE DNA HIV W/CLT 1ST 10

Facility

$173.08

Service Code	HCPCS 87903
Hospital Charge Code	401387903A
Hospital Revenue Code	306
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$1,763.92
Rate for Payer: Aetna Commercial	$1,329.16
Rate for Payer: Aetna Medicare Advantage	$1,583.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,763.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,763.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$488.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$535.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,763.92
Rate for Payer: Cigna Commercial	$86.54
Rate for Payer: Cigna Medicare Advantage	$488.66
Rate for Payer: Clover Medicare Advantage	$464.23
Rate for Payer: EmblemHealth Commercial	$1,465.98
Rate for Payer: Humana Medicare Advantage	$503.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$488.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$390.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$488.66
Rate for Payer: Wellcare Medicare Advantage	$488.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

PHENOTYPE DNA HIV W/CLT 1ST 10

Facility

$173.08

Service Code	HCPCS 87903
Hospital Charge Code	401387903A
Hospital Revenue Code	306
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$25.96
Rate for Payer: Qualcare PPO/HMO/WC	$25.96

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904A
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904C
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904K
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904J
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904E
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904H
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904G
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904G
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904K
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904F
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904D
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904I
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904I
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904F
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904E
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904B
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904J
Hospital Revenue Code	306
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

Know your out-of-pocket cost for care.

All Charges