Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE INJ 1% 1ML

Facility

$15.40

Hospital Charge Code	6009013
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

PHENYLEPHRINE INJ 1% 1ML

Facility

$15.40

Hospital Charge Code	6009013
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

PHENYLEPHRINE NASAL 0.25% SOLN

Facility

$30.08

Service Code	NDC 24134803
Hospital Charge Code	6004212
Hospital Revenue Code	251
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: Aetna Commercial	$9.02
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.67
Rate for Payer: Cigna Commercial	$15.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.04
Rate for Payer: UnitedHealthcare Commercial	$15.04

PHENYLEPHRINE NASAL 0.25% SOLN

Facility

$30.08

Service Code	NDC 24134803
Hospital Charge Code	6004212
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE NASAL 0.5% SPR

Facility

$43.48

Service Code	NDC 24135301
Hospital Charge Code	60628081
Hospital Revenue Code	250
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$13.04
Rate for Payer: Aetna Medicare Advantage	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.09
Rate for Payer: Cigna Commercial	$21.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.65
Rate for Payer: Oxford Commercial	$21.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.52
Rate for Payer: UnitedHealthcare Commercial	$21.74

PHENYLEPHRINE NASAL 0.5% SPR

Facility

$43.48

Service Code	NDC 24135301
Hospital Charge Code	60628081
Hospital Revenue Code	250
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$6.52
Rate for Payer: Qualcare PPO/HMO/WC	$6.52

PHENYLEPHRINE NASAL 1% SOLN

Facility

$43.48

Service Code	NDC 24135202
Hospital Charge Code	6004261
Hospital Revenue Code	251
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$6.52
Rate for Payer: Qualcare PPO/HMO/WC	$6.52

PHENYLEPHRINE NASAL 1% SOLN

Facility

$43.48

Service Code	NDC 24135202
Hospital Charge Code	6004261
Hospital Revenue Code	251
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$13.04
Rate for Payer: Aetna Medicare Advantage	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.09
Rate for Payer: Cigna Commercial	$21.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.65
Rate for Payer: Oxford Commercial	$21.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.52
Rate for Payer: UnitedHealthcare Commercial	$21.74

PHENYLEPHRINE NSL 0.255

Facility

$21.15

Hospital Charge Code	6013114
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PHENYLEPHRINE NSL 0.255

Facility

$21.15

Hospital Charge Code	6013114
Hospital Revenue Code	251
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

PHENYLEPHRINE NSL 1%

Facility

$26.90

Hospital Charge Code	6013122
Hospital Revenue Code	251
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$13.45

PHENYLEPHRINE NSL 1%

Facility

$26.90

Hospital Charge Code	6013122
Hospital Revenue Code	251
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

PHENYLEPHRINE NSL 1.0% 15ML

Facility

$34.60

Hospital Charge Code	6004238
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PHENYLEPHRINE NSL 1.0% 15ML

Facility

$34.60

Hospital Charge Code	6004238
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

PHENYLEPHRINE NSL .125% 15ML

Facility

$34.60

Hospital Charge Code	6004204
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

PHENYLEPHRINE NSL .125% 15ML

Facility

$34.60

Hospital Charge Code	6004204
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PHENYLEPHRINE NSL .5% 15ML

Facility

$30.10

Hospital Charge Code	6004220
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE NSL .5% 15ML

Facility

$30.10

Hospital Charge Code	6004220
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 SOL NSL 0.125%

Facility

$30.10

Hospital Charge Code	60628078
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

PHENYLEPHRINE SOL NSL 0.125%

Facility

$30.10

Hospital Charge Code	60628078
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 SOL OPH 10% 5ML

Facility

$24.35

Hospital Charge Code	6004253
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$12.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$12.18

PHENYLEPHRINE SOL OPH 10% 5ML

Facility

$24.35

Hospital Charge Code	6004253
Hospital Revenue Code	251
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

PHENYLEPHRINE SOL OPH 2.5%

Facility

$12.80

Hospital Charge Code	60628683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

PHENYLEPHRINE SOL OPH 2.5%

Facility

$12.80

Hospital Charge Code	60628683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

PHENYLEPHRINE SOL OPH 2.5% 5ML

Facility

$408.37

Service Code	NDC 17478020115
Hospital Charge Code	6004246
Hospital Revenue Code	251
Min. Negotiated Rate	$61.26
Max. Negotiated Rate	$61.26
Rate for Payer: Qualcare PPO/HMO/WC	$61.26

Know your out-of-pocket cost for care.

All Charges