Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL

Facility

$297.00

Service Code	HCPCS 80184
Hospital Charge Code	38479456
Hospital Revenue Code	301
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.50
Rate for Payer: Cigna Commercial	$148.50
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

PHENOBARBITAL 15 MG TAB

Facility

$4.00

Service Code	NDC 143144505
Hospital Charge Code	60627735
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PHENOBARBITAL 15 MG TAB

Facility

$4.00

Service Code	NDC 143144505
Hospital Charge Code	60627735
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PHENOBARBITAL 16.2 MG TAB

Facility

$49.25

Service Code	NDC 63739020010
Hospital Charge Code	60630124
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$7.39
Rate for Payer: Qualcare PPO/HMO/WC	$7.39

PHENOBARBITAL 16.2 MG TAB

Facility

$49.25

Service Code	NDC 63739020010
Hospital Charge Code	60630124
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.62
Rate for Payer: Aetna Commercial	$18.71
Rate for Payer: Aetna Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$24.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.80
Rate for Payer: Oxford Commercial	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$7.39
Rate for Payer: UnitedHealthcare Commercial	$9.85
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

PHENOBARBITAL 30 MG TAB

Facility

$4.00

Service Code	NDC 49999039430
Hospital Charge Code	60627736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PHENOBARBITAL 30 MG TAB

Facility

$4.00

Service Code	NDC 49999039430
Hospital Charge Code	60627736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
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	$1.04
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	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PHENOBARBITAL 32.4 MG TAB

Facility

$57.96

Service Code	NDC 63739020110
Hospital Charge Code	60630125
Hospital Revenue Code	250
Min. Negotiated Rate	$8.69
Max. Negotiated Rate	$8.69
Rate for Payer: Qualcare PPO/HMO/WC	$8.69

PHENOBARBITAL 32.4 MG TAB

Facility

$57.96

Service Code	NDC 63739020110
Hospital Charge Code	60630125
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$28.98
Rate for Payer: Aetna Commercial	$22.02
Rate for Payer: Aetna Medicare Advantage	$17.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.78
Rate for Payer: Cigna Commercial	$28.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.07
Rate for Payer: Oxford Commercial	$11.59
Rate for Payer: Qualcare PPO/HMO/WC	$8.69
Rate for Payer: UnitedHealthcare Commercial	$11.59
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

PHENOBARBITAL 65 MG/ML INJ

Facility

$128.64

Service Code	HCPCS J2560
Hospital Charge Code	60629199
Hospital Revenue Code	636
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$31.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.13
Rate for Payer: Qualcare PPO/HMO/WC	$19.30

PHENOBARBITAL 65 MG/ML INJ

Facility

$128.64

Service Code	HCPCS J2560
Hospital Charge Code	60629199
Hospital Revenue Code	636
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$64.32
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Medicare Advantage	$38.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.80
Rate for Payer: Cigna Commercial	$64.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.13
Rate for Payer: Qualcare PPO/HMO/WC	$19.30
Rate for Payer: UnitedHealthcare Community & State	$4.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

PHENOBARBITAL LQ 20MG/5ML

Facility

$6.50

Service Code	NDC 603150858
Hospital Charge Code	6023386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

PHENOBARBITAL LQ 20MG/5ML

Facility

$6.50

Service Code	NDC 603150858
Hospital Charge Code	6023386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

PHENOBARBITAL,SERUM

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39900006
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHENOBARBITAL,SERUM

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39900006
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PHENOBARBITAL SYRG 130MG/1ML

Facility

$333.86

Service Code	HCPCS J2560
Hospital Charge Code	60627737
Hospital Revenue Code	636
Min. Negotiated Rate	$50.08
Max. Negotiated Rate	$80.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.79
Rate for Payer: Qualcare PPO/HMO/WC	$50.08

PHENOBARBITAL SYRG 130MG/1ML

Facility

$333.86

Service Code	HCPCS J2560
Hospital Charge Code	60627737
Hospital Revenue Code	636
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$166.93
Rate for Payer: Aetna Commercial	$126.87
Rate for Payer: Aetna Medicare Advantage	$100.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.13
Rate for Payer: Cigna Commercial	$166.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.79
Rate for Payer: Qualcare PPO/HMO/WC	$50.08
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: Wellpoint Medicaid Managed Care	$9.48

PHENOL 1.4% THROAT SPRAY

Facility

$19.97

Service Code	NDC 536242558
Hospital Charge Code	60628681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$9.98
Rate for Payer: Aetna Commercial	$7.59
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.09
Rate for Payer: Cigna Commercial	$9.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.19
Rate for Payer: Oxford Commercial	$3.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$3.99
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

PHENOL 1.4% THROAT SPRAY

Facility

$19.97

Service Code	NDC 536242558
Hospital Charge Code	60628681
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

PHENOL EZ SWABS

Facility

$38.12

Service Code	NDC 884629730
Hospital Charge Code	6063943230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.72

PHENOL EZ SWABS

Facility

$38.12

Service Code	NDC 884629730
Hospital Charge Code	6063943230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$19.06
Rate for Payer: Aetna Commercial	$14.49
Rate for Payer: Aetna Medicare Advantage	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.72
Rate for Payer: Cigna Commercial	$19.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.91
Rate for Payer: Oxford Commercial	$7.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$7.62
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

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	$9.03
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	$82.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.03

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	$4.92
Max. Negotiated Rate	$1,772.61
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	$1,772.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,772.61
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	$456.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,772.61
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	$45.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$4.92

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

Know your out-of-pocket cost for care.

All Charges