Heights University Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE 0.5% OPHTH SOLN

Facility

$319.25

Hospital Charge Code	60628069
Hospital Revenue Code	250
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$47.89
Rate for Payer: Qualcare PPO/HMO/WC	$47.89

EPINEPHRINE 1:10000/0.1MG

Facility

$36.00

Hospital Charge Code	60632940
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

EPINEPHRINE 1:10000/0.1MG

Facility

$36.00

Hospital Charge Code	60632940
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

EPINEPHRINE 1 1000 NASAL SOL

Facility

$718.64

Service Code	NDC 42023010301
Hospital Charge Code	60627451
Hospital Revenue Code	250
Min. Negotiated Rate	$93.42
Max. Negotiated Rate	$359.32
Rate for Payer: Aetna Commercial	$215.59
Rate for Payer: Aetna Medicare Advantage	$215.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.25
Rate for Payer: Cigna Commercial	$359.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.42
Rate for Payer: Oxford Commercial	$359.32
Rate for Payer: Qualcare PPO/HMO/WC	$107.80
Rate for Payer: UnitedHealthcare Commercial	$359.32

EPINEPHRINE 1 1000 NASAL SOL

Facility

$718.64

Service Code	NDC 42023010301
Hospital Charge Code	60627451
Hospital Revenue Code	250
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$107.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.80

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna Commercial	$4.68
Rate for Payer: Aetna Medicare Advantage	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.98
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.48
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

EPINEPHRINE 1% OPHTH SOLN

Facility

$341.65

Hospital Charge Code	60628071
Hospital Revenue Code	250
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$51.25
Rate for Payer: Qualcare PPO/HMO/WC	$51.25

EPINEPHRINE 1% OPHTH SOLN

Facility

$341.65

Hospital Charge Code	60628071
Hospital Revenue Code	250
Min. Negotiated Rate	$44.41
Max. Negotiated Rate	$170.82
Rate for Payer: Aetna Commercial	$102.50
Rate for Payer: Aetna Medicare Advantage	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.12
Rate for Payer: Cigna Commercial	$170.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.41
Rate for Payer: Oxford Commercial	$170.82
Rate for Payer: Qualcare PPO/HMO/WC	$51.25
Rate for Payer: UnitedHealthcare Commercial	$170.82

EPINEPHRINE 2% OPHTH SOLN

Facility

$373.65

Hospital Charge Code	60628073
Hospital Revenue Code	250
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$186.82
Rate for Payer: Aetna Commercial	$112.09
Rate for Payer: Aetna Medicare Advantage	$112.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.28
Rate for Payer: Cigna Commercial	$186.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.57
Rate for Payer: Oxford Commercial	$186.82
Rate for Payer: Qualcare PPO/HMO/WC	$56.05
Rate for Payer: UnitedHealthcare Commercial	$186.82

EPINEPHRINE 2% OPHTH SOLN

Facility

$373.65

Hospital Charge Code	60628073
Hospital Revenue Code	250
Min. Negotiated Rate	$56.05
Max. Negotiated Rate	$56.05
Rate for Payer: Qualcare PPO/HMO/WC	$56.05

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$16.88
Rate for Payer: Aetna Commercial	$16.88
Rate for Payer: Aetna Medicare Advantage	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.35
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

EPINEPHRINE AMP 1MG/ML

Facility

$10.90

Hospital Charge Code	6008783
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

EPINEPHRINE AMP 1MG/ML

Facility

$10.90

Hospital Charge Code	6008783
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

EPINEPHRINE INJ 1:200

Facility

$10.90

Hospital Charge Code	60627449
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

EPINEPHRINE INJ 1:200

Facility

$10.90

Hospital Charge Code	60627449
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

EPINEPHRINE INJ 5MG/ML 0.5ML

Facility

$131.85

Hospital Charge Code	6002182
Hospital Revenue Code	250
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

EPINEPHRINE INJ 5MG/ML 0.5ML

Facility

$131.85

Hospital Charge Code	6002182
Hospital Revenue Code	250
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$39.55
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.14
Rate for Payer: Oxford Commercial	$65.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$65.92

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.12

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$4.24
Rate for Payer: Aetna Medicare Advantage	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.61
Rate for Payer: Cigna Commercial	$7.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.84
Rate for Payer: Oxford Commercial	$7.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.12
Rate for Payer: UnitedHealthcare Commercial	$7.07

EPINEPHRINE NSL SOL 0.1%

Facility

$117.00

Service Code	HCPCS J7640
Hospital Charge Code	6002190
Hospital Revenue Code	294
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.21
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

EPINEPHRINE NSL SOL 0.1%

Facility

$117.00

Service Code	HCPCS J7640
Hospital Charge Code	6002190
Hospital Revenue Code	294
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

Know your out-of-pocket cost for care.

All Charges