Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904K
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904H
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904J
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904G
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904E
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904A
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904A
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904B
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904E
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904D
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904I
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904C
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904D
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904K
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904J
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904I
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904F
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904F
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904B
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904C
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904H
Hospital Revenue Code	306
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

PHENOTYPE DNA HIV W/CLTEAADDL

Facility

$172.97

Service Code	HCPCS 87904
Hospital Charge Code	401387904G
Hospital Revenue Code	306
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$86.48
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.91

PHENTOLAMINE 5 MG INJ

Facility

$1,206.00

Service Code	HCPCS J2760
Hospital Charge Code	6004196
Hospital Revenue Code	636
Min. Negotiated Rate	$180.90
Max. Negotiated Rate	$291.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90

PHENTOLAMINE 5 MG INJ

Facility

$1,206.00

Service Code	HCPCS J2760
Hospital Charge Code	6004196
Hospital Revenue Code	636
Min. Negotiated Rate	$34.25
Max. Negotiated Rate	$933.90
Rate for Payer: Aetna Commercial	$700.26
Rate for Payer: Aetna Medicare Advantage	$834.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$933.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$933.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$933.90
Rate for Payer: Cigna Medicare Advantage	$257.45
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90
Rate for Payer: UnitedHealthcare Community & State	$38.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Medicare Advantage	$257.45
Rate for Payer: Wellpoint Medicaid Managed Care	$34.25

PHENYLEPHRINE 10 MG/ML INJ

Facility

$20.97

Service Code	HCPCS J2371
Hospital Charge Code	60627464
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare Advantage	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.35
Rate for Payer: Cigna Commercial	$10.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

Know your out-of-pocket cost for care.

All Charges