Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHENYTOIN 30 MG ER CAP

Facility

$1.65

Hospital Charge Code	60629198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna Commercial	$0.63
Rate for Payer: Aetna Medicare Advantage	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.42
Rate for Payer: Cigna Commercial	$0.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.25
Rate for Payer: UnitedHealthcare Commercial	$0.33
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

PHENYTOIN 30 MG ER CAP

Facility

$1.65

Hospital Charge Code	60629198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.25

PHENYTOIN 50 MG CHEW TAB

Facility

$7.30

Service Code	NDC 71000740
Hospital Charge Code	60627742
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

PHENYTOIN 50 MG CHEW TAB

Facility

$7.30

Service Code	NDC 71000740
Hospital Charge Code	60627742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PHENYTOIN (DILANTIN)

Facility

$91.10

Service Code	HCPCS 80185
Hospital Charge Code	39900007
Hospital Revenue Code	301
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$45.55
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

PHENYTOIN (DILANTIN)

Facility

$91.10

Service Code	HCPCS 80185
Hospital Charge Code	39900007
Hospital Revenue Code	301
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$13.66
Rate for Payer: Qualcare PPO/HMO/WC	$13.66

PHENYTOIN,FREE

Facility

$390.00

Service Code	HCPCS 80186
Hospital Charge Code	39900008
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHENYTOIN,FREE

Facility

$390.00

Service Code	HCPCS 80186
Hospital Charge Code	39900008
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare Advantage	$44.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.67
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.76
Rate for Payer: Clover Medicare Advantage	$13.07
Rate for Payer: EmblemHealth Commercial	$41.28
Rate for Payer: Humana Medicare Advantage	$14.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.76
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	$11.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.76
Rate for Payer: Wellcare Medicare Advantage	$13.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PHENYTOIN, FREE, (DILANTIN) I

Facility

$103.25

Service Code	HCPCS 80185
Hospital Charge Code	3031366A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

PHENYTOIN, FREE, (DILANTIN) I

Facility

$103.25

Service Code	HCPCS 80185
Hospital Charge Code	3031366A
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

PHENYTOIN, FREE, (DILANTIN) II

Facility

$133.65

Service Code	HCPCS 80186
Hospital Charge Code	3031366B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.43
Rate for Payer: Aetna Medicare Advantage	$44.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.67
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: Cigna Medicare Advantage	$13.76
Rate for Payer: Clover Medicare Advantage	$13.07
Rate for Payer: EmblemHealth Commercial	$41.28
Rate for Payer: Humana Medicare Advantage	$14.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.76
Rate for Payer: Wellcare Medicare Advantage	$13.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

PHENYTOIN, FREE, (DILANTIN) II

Facility

$133.65

Service Code	HCPCS 80186
Hospital Charge Code	3031366B
Hospital Revenue Code	301
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

PHENYTOIN SSP 100MG/4ML UD

Facility

$57.89

Service Code	NDC 66689003601
Hospital Charge Code	60627741
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

PHENYTOIN SSP 100MG/4ML UD

Facility

$57.89

Service Code	NDC 66689003601
Hospital Charge Code	60627741
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.37
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$11.58
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

PHENYTOIN VIAL 100MG

Facility

$3.20

Hospital Charge Code	6022743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

PHENYTOIN VIAL 100MG

Facility

$3.20

Hospital Charge Code	6022743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PHENYTOIN VIAL 250MG

Facility

$3.85

Hospital Charge Code	6013130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

PHENYTOIN VIAL 250MG

Facility

$3.85

Hospital Charge Code	6013130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	366883986
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 FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	366883986
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39708031
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39708031
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, FLUID

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38473058
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PH, FLUID

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38473058
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
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	$100.50
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	$60.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
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	$5.33

PHILADELPHIA CHROMOSOME

Facility

$2,902.00

Service Code	HCPCS 88262
Hospital Charge Code	38474103
Hospital Revenue Code	311
Min. Negotiated Rate	$76.90
Max. Negotiated Rate	$1,451.00
Rate for Payer: Aetna Commercial	$341.33
Rate for Payer: Aetna Medicare Advantage	$406.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$125.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.98
Rate for Payer: Cigna Commercial	$1,451.00
Rate for Payer: Cigna Medicare Advantage	$125.49
Rate for Payer: Clover Medicare Advantage	$119.22
Rate for Payer: EmblemHealth Commercial	$376.47
Rate for Payer: Humana Medicare Advantage	$129.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$125.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$870.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$100.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$125.49
Rate for Payer: Wellcare Medicare Advantage	$125.49
Rate for Payer: Wellpoint Medicaid Managed Care	$76.90

Know your out-of-pocket cost for care.

All Charges