Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

OP

$1.29

Service Code	NDC 6068784111
Hospital Charge Code	6068784111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.65
Rate for Payer: Aetna Government	$0.65
Rate for Payer: Brighton Health Commercial	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: EmblemHealth Commercial	$0.65
Rate for Payer: Group Health Inc Commercial	$0.65
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65
Rate for Payer: Hamaspik Choice Inc Medicare	$0.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.84

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

IP

$1.29

Service Code	NDC 6068784111
Hospital Charge Code	6068784111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65

PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS

Facility

OP

$0.64

Service Code	NDC 5167241113
Hospital Charge Code	5167241113
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

PHLEBITIS

Facility

OP

$209.28

Service Code	EAPG 00597
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$209.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$209.28

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

IP

$0.49

Service Code	NDC 3932810710
Hospital Charge Code	3932810710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

OP

$0.49

Service Code	NDC 3932810710
Hospital Charge Code	3932810710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

IP

$0.89

Service Code	NDC 0486112501
Hospital Charge Code	0486112501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

IP

$0.51

Service Code	NDC 6498010401
Hospital Charge Code	6498010401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

OP

$0.89

Service Code	NDC 0486112501
Hospital Charge Code	0486112501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: EmblemHealth Commercial	$0.44
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS

Facility

OP

$0.51

Service Code	NDC 6498010401
Hospital Charge Code	6498010401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L APHERESIS SOLN

Facility

IP

$0.02

Service Code	NDC 2457111606
Hospital Charge Code	2457111606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L APHERESIS SOLN

Facility

OP

$0.02

Service Code	NDC 2457111606
Hospital Charge Code	2457111606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
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

PHYSICAL THERAPY

Facility

OP

$217.65

Service Code	EAPG 00271
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$217.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$217.65

PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN

Facility

OP

$46.97

Service Code	NDC 1747851002
Hospital Charge Code	1747851002
Hospital Revenue Code	250
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$37.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.49
Rate for Payer: Aetna Government	$23.49
Rate for Payer: Brighton Health Commercial	$35.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.94
Rate for Payer: EmblemHealth Commercial	$23.49
Rate for Payer: Group Health Inc Commercial	$23.49
Rate for Payer: Group Health Inc Medicare	$16.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.49
Rate for Payer: Hamaspik Choice Inc Medicare	$23.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.53

PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN

Facility

IP

$46.97

Service Code	NDC 1747851002
Hospital Charge Code	1747851002
Hospital Revenue Code	250
Min. Negotiated Rate	$23.49
Max. Negotiated Rate	$23.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.49

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

IP

$58.76

Service Code	HCPCS J3430
Hospital Charge Code	0409915831
Hospital Revenue Code	250
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.38

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

OP

$58.76

Service Code	HCPCS J3430
Hospital Charge Code	0409915831
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$47.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$44.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.96
Rate for Payer: EmblemHealth Commercial	$29.38
Rate for Payer: Group Health Inc Commercial	$29.38
Rate for Payer: Group Health Inc Medicare	$20.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.38
Rate for Payer: Hamaspik Choice Inc Medicare	$29.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.19

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

OP

$51.32

Service Code	HCPCS J3430
Hospital Charge Code	6909770896
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$41.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$38.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.90
Rate for Payer: EmblemHealth Commercial	$25.66
Rate for Payer: Group Health Inc Commercial	$25.66
Rate for Payer: Group Health Inc Medicare	$17.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.66
Rate for Payer: Hamaspik Choice Inc Medicare	$25.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.36

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

OP

$15.14

Service Code	HCPCS J3430
Hospital Charge Code	6846275801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$11.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.30
Rate for Payer: EmblemHealth Commercial	$7.57
Rate for Payer: Group Health Inc Commercial	$7.57
Rate for Payer: Group Health Inc Medicare	$5.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.57
Rate for Payer: Hamaspik Choice Inc Medicare	$7.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.84

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

IP

$51.32

Service Code	HCPCS J3430
Hospital Charge Code	6909770896
Hospital Revenue Code	250
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$25.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.66

PHYTONADIONE 10 MG/ML IJ SOLN

Facility

IP

$15.14

Service Code	HCPCS J3430
Hospital Charge Code	6846275801
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.57

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

IP

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770996
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

IP

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770930
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

OP

$14.40

Service Code	HCPCS J3430
Hospital Charge Code	6909770930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.79
Rate for Payer: EmblemHealth Commercial	$7.20
Rate for Payer: Group Health Inc Commercial	$7.20
Rate for Payer: Group Health Inc Medicare	$5.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20
Rate for Payer: Hamaspik Choice Inc Medicare	$7.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

PHYTONADIONE 1 MG/0.5ML IJ SOLN

Facility

IP

$59.35

Service Code	HCPCS J3430
Hospital Charge Code	7632912401
Hospital Revenue Code	250
Min. Negotiated Rate	$29.68
Max. Negotiated Rate	$29.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.68

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