St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$3.84

Service Code	NDC 61990021103
Hospital Charge Code	61990021103
Hospital Revenue Code	278
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$4.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.92
Rate for Payer: Aetna Government	$1.92
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.21
Rate for Payer: EmblemHealth Commercial	$1.92
Rate for Payer: Fidelis Medicare Advantage	$4.03
Rate for Payer: Group Health Inc Commercial	$1.92
Rate for Payer: Group Health Inc Medicare	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.50

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$4.00

Service Code	NDC 00781342292
Hospital Charge Code	00781342292
Hospital Revenue Code	278
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$5.28

Service Code	NDC 70756062210
Hospital Charge Code	70756062210
Hospital Revenue Code	278
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$5.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.04
Rate for Payer: EmblemHealth Commercial	$2.64
Rate for Payer: Fidelis Medicare Advantage	$5.54
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.43

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$5.28

Service Code	NDC 70756062210
Hospital Charge Code	70756062210
Hospital Revenue Code	278
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$5.28

Service Code	NDC 61990021202
Hospital Charge Code	61990021202
Hospital Revenue Code	278
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$4.80

Service Code	NDC 55150030110
Hospital Charge Code	55150030110
Hospital Revenue Code	278
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$1.92

Service Code	NDC 81284021125
Hospital Charge Code	81284021125
Hospital Revenue Code	278
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$2.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.96
Rate for Payer: Aetna Government	$0.96
Rate for Payer: Brighton Health Commercial	$1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: EmblemHealth Commercial	$0.96
Rate for Payer: Fidelis Medicare Advantage	$2.02
Rate for Payer: Group Health Inc Commercial	$0.96
Rate for Payer: Group Health Inc Medicare	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.96
Rate for Payer: Hamaspik Choice Inc Medicare	$0.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.25

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$4.80

Service Code	NDC 16729046503
Hospital Charge Code	16729046503
Hospital Revenue Code	278
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.40
Rate for Payer: Aetna Government	$2.40
Rate for Payer: Brighton Health Commercial	$2.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.76
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Fidelis Medicare Advantage	$5.04
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]

Facility

$2.40

Service Code	NDC 71288080876
Hospital Charge Code	71288080876
Hospital Revenue Code	278
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20

PHENYLEPHRINE IN HARD FAT 0.25 % RE SUPP [10964]

Facility

$0.36

Service Code	NDC 00904697712
Hospital Charge Code	00904697712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

PHENYLEPHRINE NASAL SOLUTION 0.5%

Facility

$8.00

Hospital Charge Code	41650476
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

PHENYLEPHRINE NASAL SOLUTION 0.5%

Facility

$8.00

Hospital Charge Code	41640476
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

PHENYLEPHRINE NASAL SOLUTION 1%

Facility

$9.00

Hospital Charge Code	41640538
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 NASAL SOLUTION 1%

Facility

$9.00

Hospital Charge Code	41650538
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 NASAL SPRAY 0.25%

Facility

$8.00

Hospital Charge Code	41640906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

PHENYLEPHRINE NASAL SPRAY 0.25%

Facility

$8.00

Hospital Charge Code	41650906
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

PHENYLEPHRINE NASAL SPRAY 0.5%

Facility

$7.72

Hospital Charge Code	41644088
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.86
Rate for Payer: Aetna Government	$3.86
Rate for Payer: Brighton Health Commercial	$5.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.25
Rate for Payer: Group Health Inc Commercial	$3.86
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86
Rate for Payer: Hamaspik Choice Inc Medicare	$3.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.02

PHENYLEPHRINE NASAL SPRAY 0.5%

Facility

$7.72

Hospital Charge Code	41654088
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.86
Rate for Payer: Aetna Government	$3.86
Rate for Payer: Brighton Health Commercial	$5.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.25
Rate for Payer: Group Health Inc Commercial	$3.86
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86
Rate for Payer: Hamaspik Choice Inc Medicare	$3.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.02

PHENYLEPHRINE NASAL SPRAY 1%

Facility

$9.00

Hospital Charge Code	41650719
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 NASAL SPRAY 1%

Facility

$9.00

Hospital Charge Code	41640719
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

PHENYTOIN 100MG/2ML INJ - 50MG

Facility

$0.71

Service Code	HCPCS J1165
Hospital Charge Code	41658404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.68
Rate for Payer: SOMOS Essential	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

PHENYTOIN 100MG/2ML INJ - 50MG

Facility

$0.71

Service Code	HCPCS J1165
Hospital Charge Code	41648404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36

PHENYTOIN 100MG/2ML INJ - 50MG

Facility

$0.71

Service Code	HCPCS J1165
Hospital Charge Code	41658404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36

PHENYTOIN 100MG/2ML INJ - 50MG

Facility

$0.71

Service Code	HCPCS J1165
Hospital Charge Code	41648404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.68
Rate for Payer: SOMOS Essential	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

PHENYTOIN 100 MG/4ML PO SUSP [37993]

Facility

$2.16

Service Code	NDC 66689003650
Hospital Charge Code	66689003650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.47
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.40

Know your out-of-pocket cost for care.

All Charges