Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESTRONE

Facility

$119.00

Service Code	HCPCS 82379
Hospital Charge Code	38478113
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

ESTRONE

Facility

$176.74

Service Code	HCPCS 82679
Hospital Charge Code	38477176
Hospital Revenue Code	301
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Qualcare PPO/HMO/WC	$26.51

ESTRONE

Facility

$176.74

Service Code	HCPCS 82679
Hospital Charge Code	38477176
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.84
Rate for Payer: Aetna Medicare Advantage	$24.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$91.42
Rate for Payer: Cigna Commercial	$24.95
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.51
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.45
Rate for Payer: Wellcare Medicare Advantage	$24.95

ESTRONE

Facility

$119.00

Service Code	HCPCS 82379
Hospital Charge Code	38478113
Hospital Revenue Code	301
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.66
Rate for Payer: Aetna Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.81
Rate for Payer: Cigna Commercial	$16.87
Rate for Payer: Cigna Medicare Advantage	$8.44
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.88
Rate for Payer: Wellcare Medicare Advantage	$16.87

ESTRONE (E1)

Facility

$233.65

Service Code	HCPCS 82679
Hospital Charge Code	3009994
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.84
Rate for Payer: Aetna Medicare Advantage	$24.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$91.42
Rate for Payer: Cigna Commercial	$24.95
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.45
Rate for Payer: Wellcare Medicare Advantage	$24.95

ESTRONE (E1)

Facility

$233.65

Service Code	HCPCS 82679
Hospital Charge Code	3009994
Hospital Revenue Code	301
Min. Negotiated Rate	$35.05
Max. Negotiated Rate	$35.05
Rate for Payer: Qualcare PPO/HMO/WC	$35.05

ESTRONE,SERUM

Facility

$390.00

Service Code	HCPCS 82679
Hospital Charge Code	39900077
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.84
Rate for Payer: Aetna Medicare Advantage	$24.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.95
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	$91.42
Rate for Payer: Cigna Commercial	$24.95
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$23.70
Rate for Payer: EmblemHealth Commercial	$74.85
Rate for Payer: Humana Medicare Advantage	$25.70
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	$24.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.45
Rate for Payer: Wellcare Medicare Advantage	$24.95

ESTRONE,SERUM

Facility

$390.00

Service Code	HCPCS 82679
Hospital Charge Code	39900077
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ESTRONE SSP INJ 2MG/ML 10ML

Facility

$70.40

Hospital Charge Code	6002331
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

ESTRONE SSP INJ 2MG/ML 10ML

Facility

$70.40

Hospital Charge Code	6002331
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

ETHACRYNIC ACID 25 MG TAB

Facility

$5.85

Hospital Charge Code	60628615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$2.92

ETHACRYNIC ACID 25 MG TAB

Facility

$5.85

Hospital Charge Code	60628615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

ETHACRYNIC ACID 50 MG INJ

Facility

$168.00

Hospital Charge Code	60629013
Hospital Revenue Code	250
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$84.00

ETHACRYNIC ACID 50 MG INJ

Facility

$168.00

Hospital Charge Code	60629013
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

ETHACRYNIC ACID INJ 50MG

Facility

$113.30

Hospital Charge Code	6002349
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

ETHACRYNIC ACID INJ 50MG

Facility

$113.30

Hospital Charge Code	6002349
Hospital Revenue Code	250
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$33.99
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$56.65
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$56.65

ETHAMBUTOL

Facility

$309.00

Service Code	HCPCS 80299
Hospital Charge Code	3009822
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

ETHAMBUTOL

Facility

$309.00

Service Code	HCPCS 80299
Hospital Charge Code	3009822
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

ETHAMBUTOL 400 MG TAB

Facility

$11.93

Service Code	NDC 68850001202
Hospital Charge Code	6009435
Hospital Revenue Code	251
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$3.58
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.55
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$5.96

ETHAMBUTOL 400 MG TAB

Facility

$11.93

Service Code	NDC 68850001202
Hospital Charge Code	6009435
Hospital Revenue Code	251
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$86.79
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$200.28
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$124.01
Max. Negotiated Rate	$476.98
Rate for Payer: Aetna Commercial	$286.19
Rate for Payer: Aetna Medicare Advantage	$286.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.26
Rate for Payer: Cigna Commercial	$476.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.01
Rate for Payer: Oxford Commercial	$476.98
Rate for Payer: Qualcare PPO/HMO/WC	$143.09
Rate for Payer: UnitedHealthcare Commercial	$476.98

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$143.09
Max. Negotiated Rate	$143.09
Rate for Payer: Qualcare PPO/HMO/WC	$143.09

ETHANOLAMINEOLEATE 50MG/ML 2ML

Facility

$1,563.78

Service Code	HCPCS J1430
Hospital Charge Code	60632280
Hospital Revenue Code	636
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$469.13
Rate for Payer: Aetna Commercial	$469.13
Rate for Payer: Aetna Medicare Advantage	$469.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.43
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

Know your out-of-pocket cost for care.

All Charges