Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

phenol topical 1.4% Spr [HMC]

Facility

OP

$26.76

Service Code	NDC 00536122858
Hospital Charge Code	3809064
Hospital Revenue Code	257
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$25.42
Rate for Payer: Aetna Commercial	$24.08
Rate for Payer: Humana Medicare Advantage	$11.24
Rate for Payer: UnitedHealthcare Commercial	$25.42
Rate for Payer: UnitedHealthcare Medicaid	$10.70
Rate for Payer: WPPA Medicare Advantage	$16.06

phenol topical 1.4% Spr [HMC]

Facility

OP

$33.81

Service Code	NDC 78112001103
Hospital Charge Code	3809064
Hospital Revenue Code	257
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$32.12
Rate for Payer: Aetna Commercial	$30.43
Rate for Payer: Humana Medicare Advantage	$14.20
Rate for Payer: UnitedHealthcare Commercial	$32.12
Rate for Payer: UnitedHealthcare Medicaid	$13.52
Rate for Payer: WPPA Medicare Advantage	$20.29

phenol topical 1.4% Spr [HMC]

Facility

IP

$25.78

Service Code	NDC 00904630521
Hospital Charge Code	3809064
Hospital Revenue Code	257
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.20
Rate for Payer: UnitedHealthcare Commercial	$24.49
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine 10 mg/mL Inj Sol [HMC]

Facility

OP

$44.00

Service Code	HCPCS J2370
Hospital Charge Code	3170179
Hospital Revenue Code	259
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$41.80
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: Humana Medicare Advantage	$18.48
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Medicaid	$17.60
Rate for Payer: WPPA Medicare Advantage	$26.40

phenylephrine 10 mg/mL Inj Sol [HMC]

Facility

IP

$44.00

Service Code	HCPCS J2370
Hospital Charge Code	3170179
Hospital Revenue Code	259
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$39.60
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine 10 mg/mL Sol

Facility

IP

$32.00

Service Code	HCPCS J2370
Hospital Charge Code	3170179
Hospital Revenue Code	259
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine 10 mg/mL Sol

Facility

OP

$32.00

Service Code	HCPCS J2370
Hospital Charge Code	3170179
Hospital Revenue Code	259
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$12.80
Rate for Payer: WPPA Medicare Advantage	$19.20

phenylephrine nasal 1% spray [HMC]

Facility

IP

$24.32

Service Code	NDC 46122014903
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.89
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine nasal 1% spray [HMC]

Facility

IP

$36.34

Service Code	NDC 00225081047
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$32.71
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$32.71
Rate for Payer: UnitedHealthcare Commercial	$34.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine nasal 1% spray [HMC]

Facility

OP

$24.32

Service Code	NDC 46122014903
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$23.10
Rate for Payer: Aetna Commercial	$21.89
Rate for Payer: Humana Medicare Advantage	$10.21
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: UnitedHealthcare Medicaid	$9.73
Rate for Payer: WPPA Medicare Advantage	$14.59

phenylephrine nasal 1% spray [HMC]

Facility

OP

$29.38

Service Code	NDC 70000013201
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$27.91
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: UnitedHealthcare Commercial	$27.91
Rate for Payer: UnitedHealthcare Medicaid	$11.75
Rate for Payer: WPPA Medicare Advantage	$17.63

phenylephrine nasal 1% spray [HMC]

Facility

OP

$36.34

Service Code	NDC 00225081047
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$34.52
Rate for Payer: Aetna Commercial	$32.71
Rate for Payer: Humana Medicare Advantage	$15.26
Rate for Payer: UnitedHealthcare Commercial	$34.52
Rate for Payer: UnitedHealthcare Medicaid	$14.54
Rate for Payer: WPPA Medicare Advantage	$21.80

phenylephrine nasal 1% spray [HMC]

Facility

IP

$29.38

Service Code	NDC 70000013201
Hospital Charge Code	3800561
Hospital Revenue Code	250
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: UnitedHealthcare Commercial	$27.91
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenylephrine topical 0.25% Sup

Facility

OP

$8.46

Service Code	NDC 00573137801
Hospital Charge Code	3805339
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$8.04
Rate for Payer: Aetna Commercial	$7.61
Rate for Payer: Humana Medicare Advantage	$3.55
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Medicaid	$3.38
Rate for Payer: WPPA Medicare Advantage	$5.08

phenylephrine topical 0.25% Sup

Facility

IP

$8.46

Service Code	NDC 00573137801
Hospital Charge Code	3805339
Hospital Revenue Code	250
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$7.61
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenytoin 100 mg ERCap [HMC]

Facility

IP

$6.92

Service Code	NDC 51672411101
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.23
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenytoin 100 mg ERCap [HMC]

Facility

OP

$7.20

Service Code	NDC 00904618761
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$6.84
Rate for Payer: Aetna Commercial	$6.48
Rate for Payer: Humana Medicare Advantage	$3.02
Rate for Payer: UnitedHealthcare Commercial	$6.84
Rate for Payer: UnitedHealthcare Medicaid	$2.88
Rate for Payer: WPPA Medicare Advantage	$4.32

phenytoin 100 mg ERCap [HMC]

Facility

IP

$7.04

Service Code	NDC 51079090520
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenytoin 100 mg ERCap [HMC]

Facility

OP

$7.04

Service Code	NDC 51079090520
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$6.69
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Humana Medicare Advantage	$2.96
Rate for Payer: UnitedHealthcare Commercial	$6.69
Rate for Payer: UnitedHealthcare Medicaid	$2.82
Rate for Payer: WPPA Medicare Advantage	$4.22

phenytoin 100 mg ERCap [HMC]

Facility

IP

$7.20

Service Code	NDC 00904618761
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.48
Rate for Payer: UnitedHealthcare Commercial	$6.84
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenytoin 100 mg ERCap [HMC]

Facility

OP

$6.92

Service Code	NDC 51672411101
Hospital Charge Code	3806573
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$6.23
Rate for Payer: Humana Medicare Advantage	$2.91
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: UnitedHealthcare Medicaid	$2.77
Rate for Payer: WPPA Medicare Advantage	$4.15

phenytoin 125 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.44

Service Code	NDC 60432013108
Hospital Charge Code	3803695
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$10.87
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: Humana Medicare Advantage	$4.80
Rate for Payer: UnitedHealthcare Commercial	$10.87
Rate for Payer: UnitedHealthcare Medicaid	$4.58
Rate for Payer: WPPA Medicare Advantage	$6.86

phenytoin 125 mg/5 mL Oral Susp [HMC]

Facility

OP

$11.56

Service Code	NDC 51672406901
Hospital Charge Code	3803695
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$10.98
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Humana Medicare Advantage	$4.86
Rate for Payer: UnitedHealthcare Commercial	$10.98
Rate for Payer: UnitedHealthcare Medicaid	$4.62
Rate for Payer: WPPA Medicare Advantage	$6.94

phenytoin 125 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.44

Service Code	NDC 60432013108
Hospital Charge Code	3803695
Hospital Revenue Code	250
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: UnitedHealthcare Commercial	$10.87
Rate for Payer: WPPA Medicare Advantage	$1,200.00

phenytoin 125 mg/5 mL Oral Susp [HMC]

Facility

IP

$11.56

Service Code	NDC 51672406901
Hospital Charge Code	3803695
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: UnitedHealthcare Commercial	$10.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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