Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PHOSPHATIDY GLYCEROL

Facility

$131.38

Service Code	HCPCS 84999
Hospital Charge Code	38478103
Hospital Revenue Code	301
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.92
Rate for Payer: Aetna Medicare Advantage	$39.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.50
Rate for Payer: Cigna Commercial	$65.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.71
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.17
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

PHOSPHATIDY GLYCEROL

Facility

$131.38

Service Code	HCPCS 84999
Hospital Charge Code	38478103
Hospital Revenue Code	301
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$19.71
Rate for Payer: Qualcare PPO/HMO/WC	$19.71

PHOSPHATIDYLGLYCEROL,AMNIOTIC

Facility

$348.00

Service Code	HCPCS 84081
Hospital Charge Code	38473118
Hospital Revenue Code	301
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$52.20

PHOSPHATIDYLGLYCEROL,AMNIOTIC

Facility

$348.00

Service Code	HCPCS 84081
Hospital Charge Code	38473118
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$174.00
Rate for Payer: Aetna Commercial	$44.93
Rate for Payer: Aetna Medicare Advantage	$53.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.63
Rate for Payer: Cigna Commercial	$174.00
Rate for Payer: Cigna Medicare Advantage	$16.52
Rate for Payer: Clover Medicare Advantage	$15.69
Rate for Payer: EmblemHealth Commercial	$49.56
Rate for Payer: Humana Medicare Advantage	$17.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.52
Rate for Payer: Wellcare Medicare Advantage	$16.52
Rate for Payer: Wellpoint Medicaid Managed Care	$9.22

PHOSPH BUFFERED SAL 50ML

Facility

$3.00

Hospital Charge Code	60635085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PHOSPH BUFFERED SAL 50ML

Facility

$3.00

Hospital Charge Code	60635085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHOSPHEROUS

Facility

$141.80

Service Code	HCPCS 84100CE
Hospital Charge Code	8200323RS
Hospital Revenue Code	301
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$21.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.27

PHOSPHEROUS

Facility

$141.80

Service Code	HCPCS 84100CE
Hospital Charge Code	8200323RS
Hospital Revenue Code	301
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.88
Rate for Payer: Aetna Medicare Advantage	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.16
Rate for Payer: Cigna Commercial	$70.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

PHOSPHOHEXOSE ISOMERASE

Facility

$73.00

Service Code	HCPCS 84087
Hospital Charge Code	38477067
Hospital Revenue Code	301
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.19
Rate for Payer: Aetna Medicare Advantage	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.73
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: Cigna Medicare Advantage	$10.73
Rate for Payer: Clover Medicare Advantage	$10.19
Rate for Payer: EmblemHealth Commercial	$32.19
Rate for Payer: Humana Medicare Advantage	$11.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.73
Rate for Payer: Wellcare Medicare Advantage	$10.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

PHOSPHOHEXOSE ISOMERASE

Facility

$73.00

Service Code	HCPCS 84087
Hospital Charge Code	38477067
Hospital Revenue Code	301
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

PHOSPHOLINE IODIDE 0.25%

Facility

$129.00

Hospital Charge Code	60633661
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$49.02
Rate for Payer: Aetna Medicare Advantage	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.90
Rate for Payer: Cigna Commercial	$64.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.70
Rate for Payer: Oxford Commercial	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$25.80
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

PHOSPHOLINE IODIDE 0.25%

Facility

$129.00

Hospital Charge Code	60633661
Hospital Revenue Code	250
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

PHOSPHOLINE IODINE .03%

Facility

$74.00

Hospital Charge Code	60634554
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$28.12
Rate for Payer: Aetna Medicare Advantage	$22.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.87
Rate for Payer: Cigna Commercial	$37.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.20
Rate for Payer: Oxford Commercial	$14.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.10
Rate for Payer: UnitedHealthcare Commercial	$14.80
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

PHOSPHOLINE IODINE .03%

Facility

$74.00

Hospital Charge Code	60634554
Hospital Revenue Code	250
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$11.10
Rate for Payer: Qualcare PPO/HMO/WC	$11.10

PHOSPHOLINE IODINE .06%

Facility

$107.00

Hospital Charge Code	60634555
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

PHOSPHOLINE IODINE .06%

Facility

$107.00

Hospital Charge Code	60634555
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

PHOSPHOLINE IODINE .125%

Facility

$122.00

Hospital Charge Code	60634556
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

PHOSPHOLINE IODINE .125%

Facility

$122.00

Hospital Charge Code	60634556
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$46.36
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.60
Rate for Payer: Oxford Commercial	$24.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$24.40
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

PHOSPHOLIPASE A2 RECEP AB IFA

Facility

$198.10

Service Code	HCPCS 86255
Hospital Charge Code	401186255A
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$99.05
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.71
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

PHOSPHOLIPASE A2 RECEP AB IFA

Facility

$198.10

Service Code	HCPCS 86255
Hospital Charge Code	401186255A
Hospital Revenue Code	302
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$29.71
Rate for Payer: Qualcare PPO/HMO/WC	$29.71

PHOSPHOLIPIDS

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900135
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHOSPHOLIPIDS

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900135
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
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	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PHOSPHOLIPIDS

Facility

$383.25

Service Code	HCPCS 84311
Hospital Charge Code	3007579
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.24
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

PHOSPHOLIPIDS

Facility

$383.25

Service Code	HCPCS 84311
Hospital Charge Code	3007579
Hospital Revenue Code	301
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

PHOSPHOROUS URINE

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	39990241H
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
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	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges