Heights University Hospital

All Charges

Charge

Type

Setting

Price

EFFEXOR/37.5MG

Facility

$5.00

Hospital Charge Code	60634991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

EFFEXOR/50MG

Facility

$6.00

Hospital Charge Code	60634993
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

EFFEXOR/50MG

Facility

$6.00

Hospital Charge Code	60634993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

EFFEXOR/75MG

Facility

$5.00

Hospital Charge Code	60634994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

EFFEXOR/75MG

Facility

$5.00

Hospital Charge Code	60634994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

EFFEXOR XR 150MG U/D

Facility

$71.76

Service Code	NDC 8083603
Hospital Charge Code	60635227
Hospital Revenue Code	250
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$35.88
Rate for Payer: Aetna Commercial	$21.53
Rate for Payer: Aetna Medicare Advantage	$21.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.30
Rate for Payer: Cigna Commercial	$35.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.33
Rate for Payer: Oxford Commercial	$35.88
Rate for Payer: Qualcare PPO/HMO/WC	$10.76
Rate for Payer: UnitedHealthcare Commercial	$35.88

EFFEXOR XR 150MG U/D

Facility

$71.76

Service Code	NDC 8083603
Hospital Charge Code	60635227
Hospital Revenue Code	250
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$10.76

EFFEXOR XR 75MG U/D

Facility

$7.00

Hospital Charge Code	60635226
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

EFFEXOR XR 75MG U/D

Facility

$7.00

Hospital Charge Code	60635226
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

EFFIENT 10 MG TABLET

Facility

$32.70

Hospital Charge Code	60630036
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Qualcare PPO/HMO/WC	$4.91

EFFIENT 10 MG TABLET

Facility

$32.70

Hospital Charge Code	60630036
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$16.35
Rate for Payer: Aetna Commercial	$9.81
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.34
Rate for Payer: Cigna Commercial	$16.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.25
Rate for Payer: Oxford Commercial	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.91
Rate for Payer: UnitedHealthcare Commercial	$16.35

EFODINE/30GM

Facility

$1.00

Hospital Charge Code	60632926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

EFODINE/30GM

Facility

$1.00

Hospital Charge Code	60632926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

EFUDEX 5%/25GM

Facility

$167.00

Hospital Charge Code	60632927
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

EFUDEX 5%/25GM

Facility

$167.00

Hospital Charge Code	60632927
Hospital Revenue Code	250
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.71
Rate for Payer: Oxford Commercial	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$83.50

EGD CONTROL BLEEDING ANY

Facility

$12,832.50

Service Code	HCPCS 43255
Hospital Charge Code	16000963
Hospital Revenue Code	360
Min. Negotiated Rate	$1,924.88
Max. Negotiated Rate	$1,924.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.88

EGD CONTROL BLEEDING ANY

Facility

$12,832.50

Service Code	HCPCS 43255
Hospital Charge Code	16000963
Hospital Revenue Code	360
Min. Negotiated Rate	$1,668.22
Max. Negotiated Rate	$4,569.67
Rate for Payer: Aetna Commercial	$3,849.75
Rate for Payer: Aetna Medicare Advantage	$3,849.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,272.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,272.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,272.29
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,668.22
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.88
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EGD - EMERGENCY***

Facility

$527.00

Hospital Charge Code	2300481
Hospital Revenue Code	361
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$79.05
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

EGD - EMERGENCY***

Facility

$527.00

Hospital Charge Code	2300481
Hospital Revenue Code	361
Min. Negotiated Rate	$68.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$158.10
Rate for Payer: Aetna Medicare Advantage	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.38
Rate for Payer: Cigna Commercial	$263.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.51
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

EGD-OSCOPY W/ATTEMPTED PEG***

Facility

$340.00

Service Code	HCPCS 99999
Hospital Charge Code	2300291
Hospital Revenue Code	759
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$102.00
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

EGD-OSCOPY W/ATTEMPTED PEG***

Facility

$340.00

Service Code	HCPCS 99999
Hospital Charge Code	2300291
Hospital Revenue Code	759
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

EGDOSCOPY W/BALLN DILATATION**

Facility

$356.00

Hospital Charge Code	2300192
Hospital Revenue Code	759
Min. Negotiated Rate	$53.40
Max. Negotiated Rate	$53.40
Rate for Payer: Qualcare PPO/HMO/WC	$53.40

EGDOSCOPY W/BALLN DILATATION**

Facility

$356.00

Hospital Charge Code	2300192
Hospital Revenue Code	759
Min. Negotiated Rate	$46.28
Max. Negotiated Rate	$178.00
Rate for Payer: Aetna Commercial	$106.80
Rate for Payer: Aetna Medicare Advantage	$106.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.78
Rate for Payer: Cigna Commercial	$178.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.28
Rate for Payer: Qualcare PPO/HMO/WC	$53.40

EGD-OSCOPY W/BICAP CAUT***

Facility

$351.00

Hospital Charge Code	2300119
Hospital Revenue Code	759
Min. Negotiated Rate	$45.63
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$105.30
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.63
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

EGD-OSCOPY W/BICAP CAUT***

Facility

$351.00

Hospital Charge Code	2300119
Hospital Revenue Code	759
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

Know your out-of-pocket cost for care.

All Charges