Heights University Hospital

All Charges

Charge

Type

Setting

Price

PH CAPSULE/BRAVO SYSTEM

Facility

$1,125.00

Hospital Charge Code	270656806
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.25
Rate for Payer: Oxford Commercial	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$562.50

PH CAPSULE/BRAVO SYSTEM

Facility

$1,125.00

Hospital Charge Code	270656806
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

PH CONT STRIPS 6.0-8.0 12VIALS

Facility

$7.55

Hospital Charge Code	270652775
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.13

PH CONT STRIPS 6.0-8.0 12VIALS

Facility

$7.55

Hospital Charge Code	270652775
Hospital Revenue Code	272
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.77
Rate for Payer: Aetna Commercial	$2.27
Rate for Payer: Aetna Medicare Advantage	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.93
Rate for Payer: Cigna Commercial	$3.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.13
Rate for Payer: UnitedHealthcare Commercial	$3.77

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$9.04
Rate for Payer: Aetna Commercial	$5.43
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$9.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Oxford Commercial	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Commercial	$9.04

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$13.40

PHENCYCLIDINE PCP, SERUM

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3007648
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PHENCYCLIDINE PCP, SERUM

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3007648
Hospital Revenue Code	301
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENCYCLIDINE PCP, URINE

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3008224
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

PHENCYCLIDINE PCP, URINE

Facility

$128.00

Service Code	HCPCS 83992
Hospital Charge Code	3008224
Hospital Revenue Code	301
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$32.89
Max. Negotiated Rate	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: Aetna Commercial	$75.90
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$160.80
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENELZINE 15 MG TAB

Facility

$4.85

Hospital Charge Code	60627780
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

PHENELZINE 15 MG TAB

Facility

$5.63

Service Code	NDC 43386036021
Hospital Charge Code	606390055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

PHENELZINE 15 MG TAB

Facility

$4.85

Hospital Charge Code	60627780
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

PHENELZINE 15 MG TAB

Facility

$5.63

Service Code	NDC 43386036021
Hospital Charge Code	606390055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$2.81

PHENERGAN 25MG

Facility

$21.15

Hospital Charge Code	6008171
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
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	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

PHENERGAN 25MG

Facility

$21.15

Hospital Charge Code	6008171
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PHENERGAN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PHENERGAN/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHENERGAN SUPP/25MG

Facility

$4.00

Hospital Charge Code	60634634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

Know your out-of-pocket cost for care.

All Charges