Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE ANTY SOL OPH 21M

Facility

$41.60

Hospital Charge Code	6004279
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

PHENYLEPHRINE ANTY SOL OPH 21M

Facility

$41.60

Hospital Charge Code	6004279
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

PHENYLEPHRINE DROP NSL 0.25%

Facility

$30.10

Hospital Charge Code	60628079
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE DROP NSL 0.25%

Facility

$30.10

Hospital Charge Code	60628079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

PHENYLEPHRINE DROP NSL 0.5%

Facility

$31.40

Hospital Charge Code	60628080
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

PHENYLEPHRINE DROP NSL 0.5%

Facility

$31.40

Hospital Charge Code	60628080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$11.93
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.42
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$6.28
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

PHENYLEPHRINE HCL SOL DPH 10%

Facility

$194.97

Service Code	NDC 42702010305
Hospital Charge Code	60628077
Hospital Revenue Code	250
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PHENYLEPHRINE HCL SOL DPH 10%

Facility

$194.97

Service Code	NDC 42702010305
Hospital Charge Code	60628077
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.48
Rate for Payer: Aetna Commercial	$74.09
Rate for Payer: Aetna Medicare Advantage	$58.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.72
Rate for Payer: Cigna Commercial	$97.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.49
Rate for Payer: Oxford Commercial	$38.99
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$38.99
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

PHENYLEPHRINE INJ 1% 1ML

Facility

$15.40

Hospital Charge Code	6009013
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

PHENYLEPHRINE INJ 1% 1ML

Facility

$15.40

Hospital Charge Code	6009013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

PHENYLEPHRINE NASAL 0.25% SOLN

Facility

$30.08

Service Code	NDC 24134803
Hospital Charge Code	6004212
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE NASAL 0.25% SOLN

Facility

$30.08

Service Code	NDC 24134803
Hospital Charge Code	6004212
Hospital Revenue Code	251
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.04
Rate for Payer: Aetna Commercial	$11.43
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.67
Rate for Payer: Cigna Commercial	$15.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.02
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

PHENYLEPHRINE NASAL 0.5% SPR

Facility

$43.48

Service Code	NDC 24135301
Hospital Charge Code	60628081
Hospital Revenue Code	250
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$6.52
Rate for Payer: Qualcare PPO/HMO/WC	$6.52

PHENYLEPHRINE NASAL 0.5% SPR

Facility

$43.48

Service Code	NDC 24135301
Hospital Charge Code	60628081
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$16.52
Rate for Payer: Aetna Medicare Advantage	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.09
Rate for Payer: Cigna Commercial	$21.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.04
Rate for Payer: Oxford Commercial	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$6.52
Rate for Payer: UnitedHealthcare Commercial	$8.70
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

PHENYLEPHRINE NASAL 1% SOLN

Facility

$43.48

Service Code	NDC 24135202
Hospital Charge Code	6004261
Hospital Revenue Code	251
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$16.52
Rate for Payer: Aetna Medicare Advantage	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.09
Rate for Payer: Cigna Commercial	$21.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.04
Rate for Payer: Oxford Commercial	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$6.52
Rate for Payer: UnitedHealthcare Commercial	$8.70
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

PHENYLEPHRINE NASAL 1% SOLN

Facility

$43.48

Service Code	NDC 24135202
Hospital Charge Code	6004261
Hospital Revenue Code	251
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$6.52
Rate for Payer: Qualcare PPO/HMO/WC	$6.52

PHENYLEPHRINE NSL 0.255

Facility

$21.15

Hospital Charge Code	6013114
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PHENYLEPHRINE NSL 0.255

Facility

$21.15

Hospital Charge Code	6013114
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

PHENYLEPHRINE NSL 1%

Facility

$26.90

Hospital Charge Code	6013122
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

PHENYLEPHRINE NSL 1%

Facility

$26.90

Hospital Charge Code	6013122
Hospital Revenue Code	251
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

PHENYLEPHRINE NSL 1.0% 15ML

Facility

$34.60

Hospital Charge Code	6004238
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

PHENYLEPHRINE NSL 1.0% 15ML

Facility

$34.60

Hospital Charge Code	6004238
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PHENYLEPHRINE NSL .125% 15ML

Facility

$34.60

Hospital Charge Code	6004204
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PHENYLEPHRINE NSL .125% 15ML

Facility

$34.60

Hospital Charge Code	6004204
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

PHENYLEPHRINE NSL .5% 15ML

Facility

$30.10

Hospital Charge Code	6004220
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

Know your out-of-pocket cost for care.

All Charges