Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE SOL OPH 2.5% 5ML

Facility

$408.37

Service Code	NDC 17478020115
Hospital Charge Code	6004246
Hospital Revenue Code	251
Min. Negotiated Rate	$53.09
Max. Negotiated Rate	$204.19
Rate for Payer: Aetna Commercial	$122.51
Rate for Payer: Aetna Medicare Advantage	$122.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.13
Rate for Payer: Cigna Commercial	$204.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.09
Rate for Payer: Oxford Commercial	$204.19
Rate for Payer: Qualcare PPO/HMO/WC	$61.26
Rate for Payer: UnitedHealthcare Commercial	$204.19

PHENYLEPHRINE SPR 1/8% 15ML

Facility

$21.15

Hospital Charge Code	6013106
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PHENYLEPHRINE SPR 1/8% 15ML

Facility

$21.15

Hospital Charge Code	6013106
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

PHENYLPROP/PHENYLEPH DROP

Facility

$48.00

Hospital Charge Code	6004295
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

PHENYLPROP/PHENYLEPH DROP

Facility

$48.00

Hospital Charge Code	6004295
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

PHENYLPROP/PHENYLEPH SYR 480ML

Facility

$317.45

Hospital Charge Code	6004287
Hospital Revenue Code	251
Min. Negotiated Rate	$41.27
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$95.23
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.27
Rate for Payer: Oxford Commercial	$158.72
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Commercial	$158.72

PHENYLPROP/PHENYLEPH SYR 480ML

Facility

$317.45

Hospital Charge Code	6004287
Hospital Revenue Code	251
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$47.62
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

PHENYLTOLOXAMI-ACETAMI30-325MG

Facility

$1.95

Hospital Charge Code	60627732
Hospital Revenue Code	250
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

PHENYLTOLOXAMI-ACETAMI30-325MG

Facility

$1.95

Hospital Charge Code	60627732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENYPRO/PHENYEPH/PHENYLTO/CHL

Facility

$1.95

Hospital Charge Code	60627232
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

PHENYPRO/PHENYEPH/PHENYLTO/CHL

Facility

$1.95

Hospital Charge Code	60627232
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PHENYTOIN 100 MG / 2 ML INJ

Facility

$9.25

Service Code	HCPCS J1165
Hospital Charge Code	60627743
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$2.77
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$0.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

PHENYTOIN 100 MG / 2 ML INJ

Facility

$9.25

Service Code	HCPCS J1165
Hospital Charge Code	60627743
Hospital Revenue Code	636
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

PHENYTOIN 100 MG ER CAP

Facility

$4.00

Service Code	NDC 71036940
Hospital Charge Code	6022735
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PHENYTOIN 100 MG ER CAP

Facility

$4.00

Service Code	NDC 71036940
Hospital Charge Code	6022735
Hospital Revenue Code	251
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

PHENYTOIN 250 MG / 5 ML INJ

Facility

$13.27

Service Code	HCPCS J1165
Hospital Charge Code	60627744
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

PHENYTOIN 250 MG / 5 ML INJ

Facility

$13.27

Service Code	HCPCS J1165
Hospital Charge Code	60627744
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare Advantage	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.38
Rate for Payer: Cigna Commercial	$0.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

PHENYTOIN 30 MG ER CAP

Facility

$1.65

Hospital Charge Code	60629198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: Aetna Medicare Advantage	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.42
Rate for Payer: Cigna Commercial	$0.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.25
Rate for Payer: UnitedHealthcare Commercial	$0.83

PHENYTOIN 30 MG ER CAP

Facility

$1.65

Hospital Charge Code	60629198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.25

PHENYTOIN 50 MG CHEW TAB

Facility

$7.30

Service Code	NDC 71000740
Hospital Charge Code	60627742
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

PHENYTOIN 50 MG CHEW TAB

Facility

$7.30

Service Code	NDC 71000740
Hospital Charge Code	60627742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.95
Rate for Payer: Oxford Commercial	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.65

PHENYTOIN (DILANTIN)

Facility

$91.10

Service Code	HCPCS 80185
Hospital Charge Code	39900007
Hospital Revenue Code	301
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$13.66
Rate for Payer: Qualcare PPO/HMO/WC	$13.66

PHENYTOIN (DILANTIN)

Facility

$91.10

Service Code	HCPCS 80185
Hospital Charge Code	39900007
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Aetna Commercial	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.55
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.66
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.04
Rate for Payer: Wellcare Medicare Advantage	$13.25

PHENYTOIN,FREE

Facility

$390.00

Service Code	HCPCS 80186
Hospital Charge Code	39900008
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHENYTOIN,FREE

Facility

$390.00

Service Code	HCPCS 80186
Hospital Charge Code	39900008
Hospital Revenue Code	301
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.58
Rate for Payer: Aetna Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.42
Rate for Payer: Cigna Commercial	$13.76
Rate for Payer: Cigna Medicare Advantage	$6.88
Rate for Payer: Clover Medicare Advantage	$13.07
Rate for Payer: EmblemHealth Commercial	$41.28
Rate for Payer: Humana Medicare Advantage	$14.17
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	$13.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.59
Rate for Payer: Wellcare Medicare Advantage	$13.76

Know your out-of-pocket cost for care.

All Charges