Heights University Hospital

All Charges

Charge

Type

Setting

Price

EMTRIVA ORAL SOLN 10MG/ML

Facility

$5.63

Service Code	NDC 61958060201
Hospital Charge Code	60635533
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

EMTRIVA ORAL SOLN 10MG/ML

Facility

$5.63

Service Code	NDC 61958060201
Hospital Charge Code	60635533
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$2.81

ENA AB (SM/RNP)

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990026EX
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

ENA AB (SM/RNP)

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990026EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ENA AB (SM/RNP) I

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026A
Hospital Revenue Code	306
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.98
Rate for Payer: Aetna Medicare Advantage	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.43
Rate for Payer: Cigna Commercial	$61.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

ENA AB (SM/RNP) I

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026A
Hospital Revenue Code	306
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$18.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.49

ENA AB (SM/RNP) II

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026B
Hospital Revenue Code	306
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.98
Rate for Payer: Aetna Medicare Advantage	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.43
Rate for Payer: Cigna Commercial	$61.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

ENA AB (SM/RNP) II

Facility

$123.25

Service Code	HCPCS 8623591
Hospital Charge Code	39990026B
Hospital Revenue Code	306
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$18.49
Rate for Payer: Qualcare PPO/HMO/WC	$18.49

ENALAPRIL 10 MG TAB

Facility

$10.45

Hospital Charge Code	6024178
Hospital Revenue Code	251
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

ENALAPRIL 10 MG TAB

Facility

$10.45

Hospital Charge Code	6024178
Hospital Revenue Code	251
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

ENALAPRIL 10MG TABLET

Facility

$8.71

Service Code	NDC 68084039101
Hospital Charge Code	60632216
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

ENALAPRIL 10MG TABLET

Facility

$8.71

Service Code	NDC 68084039101
Hospital Charge Code	60632216
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$2.61
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.13
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$4.36

ENALAPRIL 1.25 MG/ML INJ

Facility

$13.74

Service Code	NDC 409212201
Hospital Charge Code	6009443
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

ENALAPRIL 1.25 MG/ML INJ

Facility

$13.74

Service Code	NDC 409212201
Hospital Charge Code	6009443
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$6.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$6.87

ENALAPRIL 2.5MG 2ML INJ

Facility

$23.25

Service Code	NDC 409212202
Hospital Charge Code	6063943103
Hospital Revenue Code	250
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.49

ENALAPRIL 2.5MG 2ML INJ

Facility

$23.25

Service Code	NDC 409212202
Hospital Charge Code	6063943103
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$11.62
Rate for Payer: Aetna Commercial	$6.97
Rate for Payer: Aetna Medicare Advantage	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.93
Rate for Payer: Cigna Commercial	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.02
Rate for Payer: Oxford Commercial	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.49
Rate for Payer: UnitedHealthcare Commercial	$11.62

ENALAPRIL 2.5 MG/ML INJ

Facility

$18.00

Hospital Charge Code	6009450
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

ENALAPRIL 2.5 MG/ML INJ

Facility

$18.00

Hospital Charge Code	6009450
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
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	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

ENALAPRIL 2.5 MG TAB

Facility

$4.00

Hospital Charge Code	60629827
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ENALAPRIL 2.5 MG TAB

Facility

$4.00

Hospital Charge Code	60629827
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ENALAPRIL 2.5MG TABLET

Facility

$9.78

Service Code	NDC 904560961
Hospital Charge Code	60632217
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

ENALAPRIL 2.5MG TABLET

Facility

$9.78

Service Code	NDC 904560961
Hospital Charge Code	60632217
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$4.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$4.89

ENALAPRIL 5 MG TAB

Facility

$9.65

Hospital Charge Code	6024186
Hospital Revenue Code	251
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

ENALAPRIL 5 MG TAB

Facility

$9.65

Hospital Charge Code	6024186
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

enalaprilat

Facility

$10.01

Hospital Charge Code	6063943301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

Know your out-of-pocket cost for care.

All Charges