Heights University Hospital

All Charges

Charge

Type

Setting

Price

ERYTHROPOIETIN INJ 1,000U

Facility

$48.00

Hospital Charge Code	6017420
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

ERYTHROPOIETIN INJ 5,000U***

Facility

$117.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017438
Hospital Revenue Code	634
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

ERYTHROPOIETIN INJ 5,000U***

Facility

$117.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017438
Hospital Revenue Code	634
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: Oxford Commercial	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$58.50

ERYTHROPOIETIN INJ 6,000U****

Facility

$140.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017347
Hospital Revenue Code	634
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

ERYTHROPOIETIN INJ 6,000U****

Facility

$140.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017347
Hospital Revenue Code	634
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$70.00

ERYTHROPOIETIN INJ 7,000U***

Facility

$164.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017446
Hospital Revenue Code	634
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$82.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$82.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$82.00

ERYTHROPOIETIN INJ 7,000U***

Facility

$164.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017446
Hospital Revenue Code	634
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

ERYTHROPOIETIN INJ 8,000U***

Facility

$187.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017354
Hospital Revenue Code	634
Min. Negotiated Rate	$24.31
Max. Negotiated Rate	$93.50
Rate for Payer: Aetna Commercial	$56.10
Rate for Payer: Aetna Medicare Advantage	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.69
Rate for Payer: Cigna Commercial	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.31
Rate for Payer: Oxford Commercial	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.05
Rate for Payer: UnitedHealthcare Commercial	$93.50

ERYTHROPOIETIN INJ 8,000U***

Facility

$187.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017354
Hospital Revenue Code	634
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$28.05
Rate for Payer: Qualcare PPO/HMO/WC	$28.05

ERYTHROPOIETIN INJ 9,000***

Facility

$211.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017453
Hospital Revenue Code	634
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

ERYTHROPOIETIN INJ 9,000***

Facility

$211.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017453
Hospital Revenue Code	634
Min. Negotiated Rate	$27.43
Max. Negotiated Rate	$105.50
Rate for Payer: Aetna Commercial	$63.30
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.43
Rate for Payer: Oxford Commercial	$105.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$105.50

ERYTHROPOIETIN SERUM

Facility

$218.45

Service Code	HCPCS 82668
Hospital Charge Code	3004140
Hospital Revenue Code	301
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

ERYTHROPOIETIN SERUM

Facility

$218.45

Service Code	HCPCS 82668
Hospital Charge Code	3004140
Hospital Revenue Code	301
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.88
Rate for Payer: Aetna Medicare Advantage	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$18.79
Rate for Payer: Cigna Medicare Advantage	$9.39
Rate for Payer: Clover Medicare Advantage	$17.85
Rate for Payer: EmblemHealth Commercial	$56.37
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.79
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.92
Rate for Payer: Wellcare Medicare Advantage	$18.79

ESCHAROTOMY SUBSEQUENT

Facility

$250.00

Service Code	HCPCS 16036
Hospital Charge Code	5780010
Hospital Revenue Code	450
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ESCHAROTOMY SUBSEQUENT

Facility

$250.00

Service Code	HCPCS 16036
Hospital Charge Code	5780010
Hospital Revenue Code	450
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$79.40
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$79.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ESCITALOPRAM 10 MG TAB

Facility

$55.07

Service Code	NDC 904642661
Hospital Charge Code	60629342
Hospital Revenue Code	250
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$27.54
Rate for Payer: Aetna Commercial	$16.52
Rate for Payer: Aetna Medicare Advantage	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.04
Rate for Payer: Cigna Commercial	$27.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.16
Rate for Payer: Oxford Commercial	$27.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.26
Rate for Payer: UnitedHealthcare Commercial	$27.54

ESCITALOPRAM 10 MG TAB

Facility

$55.07

Service Code	NDC 904642661
Hospital Charge Code	60629342
Hospital Revenue Code	250
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$8.26
Rate for Payer: Qualcare PPO/HMO/WC	$8.26

ESCITALOPRAM 20 MG TAB

Facility

$56.35

Service Code	NDC 456202001
Hospital Charge Code	60629343
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$8.45
Rate for Payer: Qualcare PPO/HMO/WC	$8.45

ESCITALOPRAM 20 MG TAB

Facility

$56.35

Service Code	NDC 456202001
Hospital Charge Code	60629343
Hospital Revenue Code	250
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$28.18
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.37
Rate for Payer: Cigna Commercial	$28.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.33
Rate for Payer: Oxford Commercial	$28.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.45
Rate for Payer: UnitedHealthcare Commercial	$28.18

ESCITALOPRAM (LEXAPRO) 5MG TAB

Facility

$27.74

Service Code	NDC 93585001
Hospital Charge Code	60630130
Hospital Revenue Code	250
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$13.87
Rate for Payer: Aetna Commercial	$8.32
Rate for Payer: Aetna Medicare Advantage	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.07
Rate for Payer: Cigna Commercial	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.61
Rate for Payer: Oxford Commercial	$13.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.16
Rate for Payer: UnitedHealthcare Commercial	$13.87

ESCITALOPRAM (LEXAPRO) 5MG TAB

Facility

$27.74

Service Code	NDC 93585001
Hospital Charge Code	60630130
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.16

ES-EPSTEIN BARR

Facility

$109.00

Service Code	HCPCS 86664
Hospital Charge Code	38479428
Hospital Revenue Code	302
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

ES-EPSTEIN BARR

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38479429
Hospital Revenue Code	306
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

ES-EPSTEIN BARR

Facility

$109.00

Service Code	HCPCS 86664
Hospital Charge Code	38479428
Hospital Revenue Code	302
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.54
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.02
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: Cigna Medicare Advantage	$7.64
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.21
Rate for Payer: Wellcare Medicare Advantage	$15.29

ES-EPSTEIN BARR

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38479429
Hospital Revenue Code	306
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.47
Rate for Payer: Aetna Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.85
Rate for Payer: Cigna Commercial	$10.33
Rate for Payer: Cigna Medicare Advantage	$5.17
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.95
Rate for Payer: Wellcare Medicare Advantage	$10.33

Know your out-of-pocket cost for care.

All Charges