Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL/30MG/TAB

Facility

$3.00

Hospital Charge Code	60633654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHENOBARBITAL/30MG/TAB

Facility

$3.00

Hospital Charge Code	60633654
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

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	$7.53
Max. Negotiated Rate	$28.98
Rate for Payer: Aetna Commercial	$17.39
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	$7.53
Rate for Payer: Oxford Commercial	$28.98
Rate for Payer: Qualcare PPO/HMO/WC	$8.69
Rate for Payer: UnitedHealthcare Commercial	$28.98

PHENOBARBITAL/60MG/TAB

Facility

$3.00

Hospital Charge Code	60633653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHENOBARBITAL/60MG/TAB

Facility

$3.00

Hospital Charge Code	60633653
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

PHENOBARBITAL/60MG/UD

Facility

$3.00

Hospital Charge Code	60634635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHENOBARBITAL/60MG/UD

Facility

$3.00

Hospital Charge Code	60634635
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

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	$19.30
Max. Negotiated Rate	$38.59
Rate for Payer: Aetna Commercial	$38.59
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	$23.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.13
Rate for Payer: Qualcare PPO/HMO/WC	$19.30

PHENOBARBITAL ELIX 5ML

Facility

$3.00

Hospital Charge Code	60635073
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

PHENOBARBITAL ELIX 5ML

Facility

$3.00

Hospital Charge Code	60635073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PHENOBARBITAL INJ 130MG/ML

Facility

$19.20

Hospital Charge Code	6017991
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.88

PHENOBARBITAL INJ 130MG/ML

Facility

$17.95

Hospital Charge Code	6016216
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

PHENOBARBITAL INJ 130MG/ML

Facility

$17.95

Hospital Charge Code	6016216
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

PHENOBARBITAL INJ 130MG/ML

Facility

$19.20

Hospital Charge Code	6017991
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$5.76
Rate for Payer: Aetna Medicare Advantage	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.90
Rate for Payer: Cigna Commercial	$9.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.88
Rate for Payer: UnitedHealthcare Commercial	$9.60

PHENOBARBITAL INJ 30MG/ML

Facility

$14.75

Hospital Charge Code	6011183
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

PHENOBARBITAL INJ 30MG/ML

Facility

$14.75

Hospital Charge Code	6011183
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$7.38

PHENOBARBITAL INJ TUB 130MG/ML

Facility

$17.95

Hospital Charge Code	6016000
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

PHENOBARBITAL INJ TUB 130MG/ML

Facility

$17.95

Hospital Charge Code	6016000
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

PHENOBARBITAL LQ 20MG/5ML

Facility

$6.50

Service Code	NDC 603150858
Hospital Charge Code	6023386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$1.95
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	$0.85
Rate for Payer: Oxford Commercial	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$3.25

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,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	$7.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.06
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	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.06
Rate for Payer: Cigna Commercial	$15.30
Rate for Payer: Cigna Medicare Advantage	$7.65
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: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.22
Rate for Payer: Wellcare Medicare Advantage	$15.30

PHENOBARBITAL SODIUM/130M

Facility

$15.00

Hospital Charge Code	60633655
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

Know your out-of-pocket cost for care.

All Charges