St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE 10 MG/ML INJ 2 ML

Facility

$6.25

Service Code	HCPCS J2370
Hospital Charge Code	41653631
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

PHENYLEPHRINE 10 MG/ML INJ 5 ML

Facility

$2.53

Service Code	HCPCS J2370
Hospital Charge Code	41655580
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.04
Rate for Payer: Aetna Government	$3.04
Rate for Payer: Brighton Health Commercial	$1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.45
Rate for Payer: Group Health Inc Commercial	$1.26
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.64

PHENYLEPHRINE 10 MG/ML INJ 5 ML

Facility

$2.53

Service Code	HCPCS J2370
Hospital Charge Code	41655580
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26

PHENYLEPHRINE 10 MG/ML INJ 5 ML

Facility

$2.53

Service Code	HCPCS J2370
Hospital Charge Code	41645580
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.04
Rate for Payer: Aetna Government	$3.04
Rate for Payer: Brighton Health Commercial	$1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.45
Rate for Payer: Group Health Inc Commercial	$1.26
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.64

PHENYLEPHRINE 10 MG/ML INJ 5 ML

Facility

$2.53

Service Code	HCPCS J2370
Hospital Charge Code	41645580
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26

PHENYLEPHRINE 10% OPHTHALMIC SOLN

Facility

$6.00

Hospital Charge Code	41650904
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

PHENYLEPHRINE 10% OPHTHALMIC SOLN

Facility

$6.00

Hospital Charge Code	41640904
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

PHENYLEPHRINE 2.5% OPHTHALMIC SOLN

Facility

$0.78

Hospital Charge Code	41651127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

PHENYLEPHRINE 2.5% OPHTHALMIC SOLN

Facility

$0.78

Hospital Charge Code	41641127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

PHENYLEPHRINE 40MG 250ML

Facility

$9.00

Hospital Charge Code	41647163
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

PHENYLEPHRINE 40MG 250ML

Facility

$9.00

Hospital Charge Code	41657163
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

PHENYLEPHRINE 40MG/MS 250ML

Facility

$24.56

Service Code	HCPCS J7799
Hospital Charge Code	41659535
Hospital Revenue Code	636
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$15.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.28
Rate for Payer: Aetna Government	$12.28
Rate for Payer: Brighton Health Commercial	$14.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.12
Rate for Payer: Group Health Inc Commercial	$12.28
Rate for Payer: Group Health Inc Medicare	$8.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.28
Rate for Payer: Hamaspik Choice Inc Medicare	$12.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.96

PHENYLEPHRINE 40MG/MS 250ML

Facility

$24.56

Service Code	HCPCS J7799
Hospital Charge Code	41659535
Hospital Revenue Code	636
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$12.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.28
Rate for Payer: Hamaspik Choice Inc Medicare	$12.28

PHENYLEPHRINE 40MG/NS 250ML

Facility

$24.56

Service Code	HCPCS J7799
Hospital Charge Code	41649535
Hospital Revenue Code	636
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$12.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.28
Rate for Payer: Hamaspik Choice Inc Medicare	$12.28

PHENYLEPHRINE 40MG/NS 250ML

Facility

$24.56

Service Code	HCPCS J7799
Hospital Charge Code	41649535
Hospital Revenue Code	636
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$15.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.28
Rate for Payer: Aetna Government	$12.28
Rate for Payer: Brighton Health Commercial	$14.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.12
Rate for Payer: Group Health Inc Commercial	$12.28
Rate for Payer: Group Health Inc Medicare	$8.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.28
Rate for Payer: Hamaspik Choice Inc Medicare	$12.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.96

PHENYLEPHRINE 80MG/NS 500 ML

Facility

$49.12

Service Code	HCPCS J7799
Hospital Charge Code	41649537
Hospital Revenue Code	636
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$24.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.56
Rate for Payer: Hamaspik Choice Inc Medicare	$24.56

PHENYLEPHRINE 80MG/NS 500 ML

Facility

$49.12

Service Code	HCPCS J7799
Hospital Charge Code	41649537
Hospital Revenue Code	636
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$31.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.56
Rate for Payer: Aetna Government	$24.56
Rate for Payer: Brighton Health Commercial	$29.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.24
Rate for Payer: Group Health Inc Commercial	$24.56
Rate for Payer: Group Health Inc Medicare	$17.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.56
Rate for Payer: Hamaspik Choice Inc Medicare	$24.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.93

PHENYLEPHRINE 80MG/NS 500ML

Facility

$49.12

Service Code	HCPCS J7799
Hospital Charge Code	41659537
Hospital Revenue Code	636
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$31.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.56
Rate for Payer: Aetna Government	$24.56
Rate for Payer: Brighton Health Commercial	$29.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.24
Rate for Payer: Group Health Inc Commercial	$24.56
Rate for Payer: Group Health Inc Medicare	$17.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.56
Rate for Payer: Hamaspik Choice Inc Medicare	$24.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.93

PHENYLEPHRINE 80MG/NS 500ML

Facility

$49.12

Service Code	HCPCS J7799
Hospital Charge Code	41659537
Hospital Revenue Code	636
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$24.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.56
Rate for Payer: Hamaspik Choice Inc Medicare	$24.56

PHENYLEPHRINE HCL 0.25 % NA SOLN [6243]

Facility

$0.26

Service Code	NDC 00225080047
Hospital Charge Code	00225080047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

PHENYLEPHRINE HCL 0.5 % NA SOLN [6244]

Facility

$0.26

Service Code	NDC 00225080547
Hospital Charge Code	00225080547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

PHENYLEPHRINE HCL 10 % OP SOLN [19636]

Facility

$10.00

Service Code	NDC 70756061430
Hospital Charge Code	70756061430
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

PHENYLEPHRINE HCL 10 % OP SOLN [19636]

Facility

$10.00

Service Code	NDC 17478020605
Hospital Charge Code	17478020605
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

PHENYLEPHRINE HCL 10 % OP SOLN [19636]

Facility

$9.60

Service Code	NDC 42702010305
Hospital Charge Code	42702010305
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.24

PHENYLEPHRINE HCL 1 % NA SOLN [6245]

Facility

$0.21

Service Code	NDC 00067208601
Hospital Charge Code	00067208601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

Know your out-of-pocket cost for care.

All Charges