Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHENTERMINE 15 MG CAP

Facility

$9.65

Hospital Charge Code	60629102
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

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	$361.80
Rate for Payer: Aetna Commercial	$361.80
Rate for Payer: Aetna Medicare Advantage	$361.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.53
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	$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

PHENYLALANINE (UR SCRN) HPLC

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3002060
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

PHENYLALANINE (UR SCRN) HPLC

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3002060
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

PHENYLANINE***

Facility

$18.00

Hospital Charge Code	3012069
Hospital Revenue Code	309
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

PHENYLANINE***

Facility

$18.00

Hospital Charge Code	3012069
Hospital Revenue Code	309
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PHENYLEPHRINE

Facility

$47.35

Hospital Charge Code	270656761
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

PHENYLEPHRINE

Facility

$47.35

Hospital Charge Code	270656761
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.16
Rate for Payer: Oxford Commercial	$23.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$23.68

PHENYLEPHRINE 10 MG/ML INJ

Facility

$20.97

Service Code	HCPCS J2371
Hospital Charge Code	60627464
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PHENYLEPHRINE 10 MG/ML INJ

Facility

$20.97

Service Code	HCPCS J2371
Hospital Charge Code	60627464
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$6.29
Rate for Payer: Aetna Commercial	$6.29
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: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PHENYLEPHRINE 10% OPHTH/1

Facility

$13.00

Hospital Charge Code	60633657
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

PHENYLEPHRINE 10% OPHTH/1

Facility

$13.00

Hospital Charge Code	60633657
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PHENYLEPHRINE 2.5% OPTH 15ML

Facility

$723.60

Service Code	NDC 42702010210
Hospital Charge Code	606361041
Hospital Revenue Code	250
Min. Negotiated Rate	$108.54
Max. Negotiated Rate	$108.54
Rate for Payer: Qualcare PPO/HMO/WC	$108.54

PHENYLEPHRINE 2.5% OPTH 15ML

Facility

$723.60

Service Code	NDC 42702010210
Hospital Charge Code	606361041
Hospital Revenue Code	250
Min. Negotiated Rate	$94.07
Max. Negotiated Rate	$361.80
Rate for Payer: Aetna Commercial	$217.08
Rate for Payer: Aetna Medicare Advantage	$217.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.52
Rate for Payer: Cigna Commercial	$361.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.07
Rate for Payer: Oxford Commercial	$361.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.54
Rate for Payer: UnitedHealthcare Commercial	$361.80

PHENYLEPHRINE AMP 10% 5ML

Facility

$30.10

Hospital Charge Code	6006456
Hospital Revenue Code	251
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

PHENYLEPHRINE AMP 10% 5ML

Facility

$30.10

Hospital Charge Code	6006456
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE ANTY SOL OPH 21M

Facility

$41.60

Hospital Charge Code	6004279
Hospital Revenue Code	251
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

PHENYLEPHRINE ANTY SOL OPH 21M

Facility

$41.60

Hospital Charge Code	6004279
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

PHENYLEPHRINE DROP NSL 0.25%

Facility

$30.10

Hospital Charge Code	60628079
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE DROP NSL 0.25%

Facility

$30.10

Hospital Charge Code	60628079
Hospital Revenue Code	250
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

PHENYLEPHRINE DROP NSL 0.5%

Facility

$31.40

Hospital Charge Code	60628080
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

PHENYLEPHRINE DROP NSL 0.5%

Facility

$31.40

Hospital Charge Code	60628080
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$9.42
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Oxford Commercial	$15.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$15.70

PHENYLEPHRINE HCL SOL DPH 10%

Facility

$194.97

Service Code	NDC 42702010305
Hospital Charge Code	60628077
Hospital Revenue Code	250
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PHENYLEPHRINE HCL SOL DPH 10%

Facility

$194.97

Service Code	NDC 42702010305
Hospital Charge Code	60628077
Hospital Revenue Code	250
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$97.48
Rate for Payer: Aetna Commercial	$58.49
Rate for Payer: Aetna Medicare Advantage	$58.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.72
Rate for Payer: Cigna Commercial	$97.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$97.48
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$97.48

Know your out-of-pocket cost for care.

All Charges