St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN

Facility

$3.84

Service Code	NDC 5515030025
Hospital Charge Code	5515030025
Hospital Revenue Code	258
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.07
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	$2.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.61
Rate for Payer: EmblemHealth Commercial	$1.92
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

Facility

$3.84

Service Code	NDC 6199002113
Hospital Charge Code	6199002113
Hospital Revenue Code	258
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.92

PHENYLEPHRINE IN HARD FAT 0.25 % RE SUPP

Facility

$0.36

Service Code	NDC 0904697712
Hospital Charge Code	0904697712
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: EmblemHealth Commercial	$0.18
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 IN HARD FAT 0.25 % RE SUPP

Facility

$0.36

Service Code	NDC 0904697712
Hospital Charge Code	0904697712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18

PHENYTOIN 100 MG/4ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903650
Hospital Charge Code	6668903650
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08

PHENYTOIN 100 MG/4ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903650
Hospital Charge Code	6668903650
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: EmblemHealth Commercial	$1.08
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

PHENYTOIN 125 MG/5ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903601
Hospital Charge Code	6668903601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08

PHENYTOIN 125 MG/5ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903650
Hospital Charge Code	6668903650
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08

PHENYTOIN 125 MG/5ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903601
Hospital Charge Code	6668903601
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: EmblemHealth Commercial	$1.08
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

PHENYTOIN 125 MG/5ML PO SUSP

Facility

$2.16

Service Code	NDC 6668903650
Hospital Charge Code	6668903650
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: EmblemHealth Commercial	$1.08
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

PHENYTOIN 50 MG PO CHEW

Facility

$1.80

Service Code	NDC 6068715625
Hospital Charge Code	6068715625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: EmblemHealth Commercial	$0.90
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

PHENYTOIN 50 MG PO CHEW

Facility

$2.68

Service Code	NDC 0071000740
Hospital Charge Code	0071000740
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34

PHENYTOIN 50 MG PO CHEW

Facility

$1.80

Service Code	NDC 6068715625
Hospital Charge Code	6068715625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90

PHENYTOIN 50 MG PO CHEW

Facility

$2.68

Service Code	NDC 0071000740
Hospital Charge Code	0071000740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: EmblemHealth Commercial	$1.34
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

PHENYTOIN 50 MG PO CHEW

Facility

$1.80

Service Code	NDC 6068715695
Hospital Charge Code	6068715695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: EmblemHealth Commercial	$0.90
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

PHENYTOIN 50 MG PO CHEW

Facility

$1.80

Service Code	NDC 6068715695
Hospital Charge Code	6068715695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90

PHENYTOIN SODIUM 50 MG/ML IJ SOLN

Facility

$0.48

Service Code	HCPCS J1165
Hospital Charge Code	0641255545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.24
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

PHENYTOIN SODIUM 50 MG/ML IJ SOLN

Facility

$0.48

Service Code	HCPCS J1165
Hospital Charge Code	0641255545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.64

Service Code	NDC 6808437601
Hospital Charge Code	6808437601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.64

Service Code	NDC 6586269299
Hospital Charge Code	6586269299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.64

Service Code	NDC 6586269299
Hospital Charge Code	6586269299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.64

Service Code	NDC 6808437601
Hospital Charge Code	6808437601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.64

Service Code	NDC 5167241113
Hospital Charge Code	5167241113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.73

Service Code	NDC 0904618761
Hospital Charge Code	0904618761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.55
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

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

$0.73

Service Code	NDC 0904618761
Hospital Charge Code	0904618761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

Know your out-of-pocket cost for care.

All Charges