Heights University Hospital

All Charges

Charge

Type

Setting

Price

DEPAHENE SUSP/16OZ

Facility

$14.00

Hospital Charge Code	60634581
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

DEPAHENE SUSP/16OZ

Facility

$14.00

Hospital Charge Code	60634581
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

DEPAKENE/250MG/CAP

Facility

$7.00

Hospital Charge Code	60632796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

DEPAKENE/250MG/CAP

Facility

$7.00

Hospital Charge Code	60632796
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DEPAKOTE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632797
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DEPAKOTE/250MG/TAB

Facility

$6.00

Hospital Charge Code	60632797
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

DEPAKOTE DELAYED RELEASE 250 MG TB

Facility

$11.79

Service Code	NDC 93744001
Hospital Charge Code	606350965
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$5.89

DEPAKOTE DELAYED RELEASE 250 MG TB

Facility

$11.79

Service Code	NDC 93744001
Hospital Charge Code	606350965
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

DEPAKOTE DELAYED RELEASE 500 MG TB

Facility

$24.12

Service Code	NDC 51079047508
Hospital Charge Code	606350945
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

DEPAKOTE DELAYED RELEASE 500 MG TB

Facility

$24.12

Service Code	NDC 51079047508
Hospital Charge Code	606350945
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.06

DEPAKOTE TAB 125 MG

Facility

$6.03

Service Code	NDC 57237004601
Hospital Charge Code	60635342
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.02

DEPAKOTE TAB 125 MG

Facility

$6.03

Service Code	NDC 57237004601
Hospital Charge Code	60635342
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DEPO-ESTRADIOL INJ/5MG/ML

Facility

$75.00

Hospital Charge Code	60634258
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DEPO-ESTRADIOL INJ/5MG/ML

Facility

$75.00

Hospital Charge Code	60634258
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DEPO MEDROL

Facility

$533.50

Hospital Charge Code	83652700
Hospital Revenue Code	250
Min. Negotiated Rate	$69.36
Max. Negotiated Rate	$266.75
Rate for Payer: Aetna Commercial	$160.05
Rate for Payer: Aetna Medicare Advantage	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.04
Rate for Payer: Cigna Commercial	$266.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.36
Rate for Payer: Oxford Commercial	$266.75
Rate for Payer: Qualcare PPO/HMO/WC	$80.03
Rate for Payer: UnitedHealthcare Commercial	$266.75

DEPO MEDROL

Facility

$533.50

Hospital Charge Code	83652700
Hospital Revenue Code	250
Min. Negotiated Rate	$80.03
Max. Negotiated Rate	$80.03
Rate for Payer: Qualcare PPO/HMO/WC	$80.03

DEPO-MEDROL/40MG/1ML

Facility

$32.00

Hospital Charge Code	60632799
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

DEPO-MEDROL/40MG/1ML

Facility

$32.00

Hospital Charge Code	60632799
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$7.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

DEPO MEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	83652561
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DEPO MEDROL 40MG VIAL

Facility

$18.00

Hospital Charge Code	83652561
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DEPO-MEDROL/80MG/1ML

Facility

$114.97

Service Code	HCPCS J1010
Hospital Charge Code	60632800
Hospital Revenue Code	636
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

DEPO-MEDROL/80MG/1ML

Facility

$114.97

Service Code	HCPCS J1010
Hospital Charge Code	60632800
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$34.49
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare Advantage	$34.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$0.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

DEPO-MEDROL INJ 5ML

Facility

$58.00

Hospital Charge Code	60635255
Hospital Revenue Code	636
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

DEPO-MEDROL INJ 5ML

Facility

$58.00

Hospital Charge Code	60635255
Hospital Revenue Code	636
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$17.40
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

DEPO-PROVERA 150MG SYRING

Facility

$186.00

Hospital Charge Code	60635270
Hospital Revenue Code	250
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

Know your out-of-pocket cost for care.

All Charges