St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL 20 MG/5ML PO ELIX

Facility

$0.74

Service Code	NDC 0121094205
Hospital Charge Code	0121094205
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

PHENOBARBITAL 20 MG/5ML PO ELIX

Facility

$0.74

Service Code	NDC 0121094205
Hospital Charge Code	0121094205
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

PHENOBARBITAL 20 MG/5ML PO ELIX

Facility

$1.07

Service Code	NDC 6068767167
Hospital Charge Code	6068767167
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

PHENOBARBITAL 32.4 MG PO TABS

Facility

$0.46

Service Code	NDC 0904657561
Hospital Charge Code	0904657561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

PHENOBARBITAL 32.4 MG PO TABS

Facility

$0.46

Service Code	NDC 0904657561
Hospital Charge Code	0904657561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	0641047721
Hospital Revenue Code	250
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$61.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: EmblemHealth Commercial	$41.04
Rate for Payer: Group Health Inc Commercial	$41.04
Rate for Payer: Group Health Inc Medicare	$28.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04
Rate for Payer: Hamaspik Choice Inc Medicare	$41.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.35

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	0641047725
Hospital Revenue Code	250
Min. Negotiated Rate	$41.04
Max. Negotiated Rate	$41.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	0641047725
Hospital Revenue Code	250
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$61.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: EmblemHealth Commercial	$41.04
Rate for Payer: Group Health Inc Commercial	$41.04
Rate for Payer: Group Health Inc Medicare	$28.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04
Rate for Payer: Hamaspik Choice Inc Medicare	$41.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.35

PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN

Facility

$82.08

Service Code	HCPCS J2560
Hospital Charge Code	0641047721
Hospital Revenue Code	250
Min. Negotiated Rate	$41.04
Max. Negotiated Rate	$41.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.04

PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN

Facility

$31.62

Service Code	HCPCS J2560
Hospital Charge Code	0641047621
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$40.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$23.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.50
Rate for Payer: EmblemHealth Commercial	$15.81
Rate for Payer: Group Health Inc Commercial	$15.81
Rate for Payer: Group Health Inc Medicare	$11.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.81
Rate for Payer: Hamaspik Choice Inc Medicare	$15.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.55

PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN

Facility

$31.62

Service Code	HCPCS J2560
Hospital Charge Code	0641047621
Hospital Revenue Code	250
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$15.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.81

PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN

Facility

$26.18

Service Code	HCPCS J2560
Hospital Charge Code	4249441525
Hospital Revenue Code	250
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$40.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$19.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.81
Rate for Payer: EmblemHealth Commercial	$13.09
Rate for Payer: Group Health Inc Commercial	$13.09
Rate for Payer: Group Health Inc Medicare	$9.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.09
Rate for Payer: Hamaspik Choice Inc Medicare	$13.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.02

PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN

Facility

$26.18

Service Code	HCPCS J2560
Hospital Charge Code	4249441525
Hospital Revenue Code	250
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$13.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.09

PHENOL 1.4 % MT LIQD

Facility

$0.05

Service Code	NDC 7811201103
Hospital Charge Code	7811201103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

PHENOL 1.4 % MT LIQD

Facility

$0.02

Service Code	NDC 0904630521
Hospital Charge Code	0904630521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

PHENOL 1.4 % MT LIQD

Facility

$0.02

Service Code	NDC 0904630521
Hospital Charge Code	0904630521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

PHENOL 1.4 % MT LIQD

Facility

$0.05

Service Code	NDC 7811201103
Hospital Charge Code	7811201103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

PHENOL 89 % EX SWAB

Facility

$5.46

Service Code	NDC 0884629730
Hospital Charge Code	0884629730
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.73
Rate for Payer: Aetna Government	$2.73
Rate for Payer: Brighton Health Commercial	$4.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.71
Rate for Payer: EmblemHealth Commercial	$2.73
Rate for Payer: Group Health Inc Commercial	$2.73
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73
Rate for Payer: Hamaspik Choice Inc Medicare	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.55

PHENOL 89 % EX SWAB

Facility

$5.46

Service Code	NDC 0884629730
Hospital Charge Code	0884629730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.73

PHENOXYBENZAMINE HCL 10 MG PO CAPS

Facility

$129.45

Service Code	NDC 4988403801
Hospital Charge Code	4988403801
Hospital Revenue Code	250
Min. Negotiated Rate	$64.72
Max. Negotiated Rate	$64.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.72

PHENOXYBENZAMINE HCL 10 MG PO CAPS

Facility

$129.45

Service Code	NDC 4988403801
Hospital Charge Code	4988403801
Hospital Revenue Code	250
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$103.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.72
Rate for Payer: Aetna Government	$64.72
Rate for Payer: Brighton Health Commercial	$97.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.02
Rate for Payer: EmblemHealth Commercial	$64.72
Rate for Payer: Group Health Inc Commercial	$64.72
Rate for Payer: Group Health Inc Medicare	$45.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.72
Rate for Payer: Hamaspik Choice Inc Medicare	$64.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.14

PHENTOLAMINE MESYLATE 5 MG IJ SOLR

Facility

$587.95

Service Code	HCPCS J2760
Hospital Charge Code	0143956401
Hospital Revenue Code	250
Min. Negotiated Rate	$302.41
Max. Negotiated Rate	$470.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$323.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$432.02
Rate for Payer: Aetna Government	$432.02
Rate for Payer: Affinity Essential Plan 1&2	$302.41
Rate for Payer: Affinity Essential Plan 3&4	$302.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$302.41
Rate for Payer: Brighton Health Commercial	$440.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$432.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$470.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$399.81
Rate for Payer: Elderplan Medicare Advantage	$432.02
Rate for Payer: EmblemHealth Commercial	$432.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$388.82
Rate for Payer: Fidelis Essential Plan Aliesa	$367.22
Rate for Payer: Fidelis Essential Plan QHP	$384.50
Rate for Payer: Fidelis Medicare Advantage	$432.02
Rate for Payer: Fidelis Qualified Health Plan	$384.50
Rate for Payer: Group Health Inc Commercial	$432.02
Rate for Payer: Group Health Inc Medicare	$432.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.02
Rate for Payer: Hamaspik Choice Inc Medicare	$432.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$432.02
Rate for Payer: Healthfirst Medicare Advantage	$367.22
Rate for Payer: Healthfirst QHP	$432.02
Rate for Payer: Humana Medicare	$440.66
Rate for Payer: Senior Whole Health Medicare Advantage	$432.02
Rate for Payer: United Healthcare Medicare Advantage	$432.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$382.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$410.42
Rate for Payer: Wellcare Medicare	$410.42

PHENTOLAMINE MESYLATE 5 MG IJ SOLR

Facility

$587.95

Service Code	HCPCS J2760
Hospital Charge Code	0143956401
Hospital Revenue Code	250
Min. Negotiated Rate	$293.98
Max. Negotiated Rate	$293.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.98

PHENYLEPHRINE HCL 0.25 % NA SOLN

Facility

$0.26

Service Code	NDC 0225080047
Hospital Charge Code	0225080047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

PHENYLEPHRINE HCL 0.25 % NA SOLN

Facility

$0.26

Service Code	NDC 0225080047
Hospital Charge Code	0225080047
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: EmblemHealth Commercial	$0.13
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

Know your out-of-pocket cost for care.

All Charges