Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

PHENOBARBITAL SODIUM/30MG

Facility

$9.00

Hospital Charge Code	60633656
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PHENOBARBITAL SODIUM/30MG

Facility

$9.00

Hospital Charge Code	60633656
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PHENOBARBITAL SYRG 130MG/1ML

Facility

$333.86

Service Code	HCPCS J2560
Hospital Charge Code	60627737
Hospital Revenue Code	636
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$100.16
Rate for Payer: Aetna Commercial	$100.16
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	$23.65
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	$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

PHENOBARB LIQ 4MG/ML 4 OZ

Facility

$90.90

Hospital Charge Code	6004188
Hospital Revenue Code	251
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

PHENOBARB LIQ 4MG/ML 4 OZ

Facility

$90.90

Hospital Charge Code	6004188
Hospital Revenue Code	251
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$45.45

PHENOL 1.4% THROAT SPRAY

Facility

$19.97

Service Code	NDC 536242558
Hospital Charge Code	60628681
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$9.98
Rate for Payer: Aetna Commercial	$5.99
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	$2.60
Rate for Payer: Oxford Commercial	$9.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$9.98

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	$4.96
Max. Negotiated Rate	$19.06
Rate for Payer: Aetna Commercial	$11.44
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	$4.96
Rate for Payer: Oxford Commercial	$19.06
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$19.06

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

PHENO/LOZENGE

Facility

$1.95

Hospital Charge Code	6024160
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

PHENO/LOZENGE

Facility

$1.95

Hospital Charge Code	6024160
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENOLPHTHALEIN, STOOL

Facility

$120.00

Service Code	HCPCS 84999
Hospital Charge Code	3035116B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

PHENOLPHTHALEIN, STOOL

Facility

$120.00

Service Code	HCPCS 84999
Hospital Charge Code	3035116A
Hospital Revenue Code	301
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENOLPHTHALEIN, STOOL

Facility

$120.00

Service Code	HCPCS 84999
Hospital Charge Code	3035116A
Hospital Revenue Code	301
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

PHENOLPHTHALEIN, STOOL

Facility

$120.00

Service Code	HCPCS 84999
Hospital Charge Code	3035116B
Hospital Revenue Code	301
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENOL TOPICAL 99% LIQ

Facility

$153.65

Hospital Charge Code	60628784
Hospital Revenue Code	250
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$46.09
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.97
Rate for Payer: Oxford Commercial	$76.83
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$76.83

PHENOL TOPICAL 99% LIQ

Facility

$153.65

Hospital Charge Code	60628784
Hospital Revenue Code	250
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

PHENOL TOPICAL - LIQ

Facility

$71.45

Hospital Charge Code	60628452
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

PHENOL TOPICAL - LIQ

Facility

$71.45

Hospital Charge Code	60628452
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$35.73
Rate for Payer: Aetna Commercial	$21.43
Rate for Payer: Aetna Medicare Advantage	$21.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.22
Rate for Payer: Cigna Commercial	$35.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.29
Rate for Payer: Oxford Commercial	$35.73
Rate for Payer: Qualcare PPO/HMO/WC	$10.72
Rate for Payer: UnitedHealthcare Commercial	$35.73

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	$41.34
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$95.40
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	$41.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$22.50
Max. Negotiated Rate	$1,790.45
Rate for Payer: Aetna Commercial	$1,583.26
Rate for Payer: Aetna Medicare Advantage	$488.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,790.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,790.45
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	$517.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,790.45
Rate for Payer: Cigna Commercial	$488.66
Rate for Payer: Cigna Medicare Advantage	$244.33
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: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.96
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$488.66
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$517.98
Rate for Payer: Wellcare Medicare Advantage	$488.66

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