Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE NSL .5% 15ML

Facility

$30.10

Hospital Charge Code	6004220
Hospital Revenue Code	251
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 SOL NSL 0.125%

Facility

$30.10

Hospital Charge Code	60628078
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 SOL NSL 0.125%

Facility

$30.10

Hospital Charge Code	60628078
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE SOL OPH 10% 5ML

Facility

$24.35

Hospital Charge Code	6004253
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$9.25
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Oxford Commercial	$4.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

PHENYLEPHRINE SOL OPH 10% 5ML

Facility

$24.35

Hospital Charge Code	6004253
Hospital Revenue Code	251
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

PHENYLEPHRINE SOL OPH 2.5%

Facility

$12.80

Hospital Charge Code	60628683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

PHENYLEPHRINE SOL OPH 2.5%

Facility

$12.80

Hospital Charge Code	60628683
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.84
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

PHENYLEPHRINE SOL OPH 2.5% 5ML

Facility

$408.37

Service Code	NDC 17478020115
Hospital Charge Code	6004246
Hospital Revenue Code	251
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$204.19
Rate for Payer: Aetna Commercial	$155.18
Rate for Payer: Aetna Medicare Advantage	$122.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.13
Rate for Payer: Cigna Commercial	$204.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.51
Rate for Payer: Oxford Commercial	$81.67
Rate for Payer: Qualcare PPO/HMO/WC	$61.26
Rate for Payer: UnitedHealthcare Commercial	$81.67
Rate for Payer: UnitedHealthcare Community & State	$9.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.82

PHENYLEPHRINE SOL OPH 2.5% 5ML

Facility

$408.37

Service Code	NDC 17478020115
Hospital Charge Code	6004246
Hospital Revenue Code	251
Min. Negotiated Rate	$61.26
Max. Negotiated Rate	$61.26
Rate for Payer: Qualcare PPO/HMO/WC	$61.26

PHENYLEPHRINE SPR 1/8% 15ML

Facility

$21.15

Hospital Charge Code	6013106
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 SPR 1/8% 15ML

Facility

$21.15

Hospital Charge Code	6013106
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PHENYLPROP/PHENYLEPH DROP

Facility

$48.00

Hospital Charge Code	6004295
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

PHENYLPROP/PHENYLEPH DROP

Facility

$48.00

Hospital Charge Code	6004295
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

PHENYLPROP/PHENYLEPH SYR 480ML

Facility

$317.45

Hospital Charge Code	6004287
Hospital Revenue Code	251
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$47.62
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

PHENYLPROP/PHENYLEPH SYR 480ML

Facility

$317.45

Hospital Charge Code	6004287
Hospital Revenue Code	251
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$120.63
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.23
Rate for Payer: Oxford Commercial	$63.49
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Commercial	$63.49
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

PHENYLTOLOXAMI-ACETAMI30-325MG

Facility

$1.95

Hospital Charge Code	60627732
Hospital Revenue Code	250
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

PHENYLTOLOXAMI-ACETAMI30-325MG

Facility

$1.95

Hospital Charge Code	60627732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENYPRO/PHENYEPH/PHENYLTO/CHL

Facility

$1.95

Hospital Charge Code	60627232
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

PHENYPRO/PHENYEPH/PHENYLTO/CHL

Facility

$1.95

Hospital Charge Code	60627232
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENYTOIN 100 MG / 2 ML INJ

Facility

$9.25

Service Code	HCPCS J1165
Hospital Charge Code	60627743
Hospital Revenue Code	636
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

PHENYTOIN 100 MG / 2 ML INJ

Facility

$9.25

Service Code	HCPCS J1165
Hospital Charge Code	60627743
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$3.52
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

PHENYTOIN 100 MG ER CAP

Facility

$4.00

Service Code	NDC 71036940
Hospital Charge Code	6022735
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PHENYTOIN 100 MG ER CAP

Facility

$4.00

Service Code	NDC 71036940
Hospital Charge Code	6022735
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
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	$1.20
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	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PHENYTOIN 250 MG / 5 ML INJ

Facility

$13.27

Service Code	HCPCS J1165
Hospital Charge Code	60627744
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna Commercial	$5.04
Rate for Payer: Aetna Medicare Advantage	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.38
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

PHENYTOIN 250 MG / 5 ML INJ

Facility

$13.27

Service Code	HCPCS J1165
Hospital Charge Code	60627744
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

Know your out-of-pocket cost for care.

All Charges