Heights University Hospital

All Charges

Charge

Type

Setting

Price

ETHYL ALCOHOL 95% GALLON

Facility

$34.60

Hospital Charge Code	6012538
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

ETHYL ALCOHOL 95% GALLON

Facility

$34.60

Hospital Charge Code	6012538
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ETHYL CHLORIDE 100% TOP SPRAY

Facility

$100.00

Hospital Charge Code	60628413
Hospital Revenue Code	250
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

ETHYL CHLORIDE 100% TOP SPRAY

Facility

$100.00

Hospital Charge Code	60628413
Hospital Revenue Code	250
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

ETHYL CHLORIDE SPRAY

Facility

$62.10

Hospital Charge Code	6012546
Hospital Revenue Code	252
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

ETHYL CHLORIDE SPRAY

Facility

$62.10

Hospital Charge Code	6012546
Hospital Revenue Code	252
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

ETHYLENE GLYCO

Facility

$103.25

Service Code	HCPCS 82963
Hospital Charge Code	3007380
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$69.60
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.70
Rate for Payer: Cigna Commercial	$21.48
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$20.41
Rate for Payer: EmblemHealth Commercial	$64.44
Rate for Payer: Humana Medicare Advantage	$22.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.77
Rate for Payer: Wellcare Medicare Advantage	$21.48

ETHYLENE GLYCO

Facility

$103.25

Service Code	HCPCS 82963
Hospital Charge Code	3007380
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.28
Rate for Payer: Aetna Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$14.90
Rate for Payer: Cigna Medicare Advantage	$7.45
Rate for Payer: Clover Medicare Advantage	$14.15
Rate for Payer: EmblemHealth Commercial	$44.70
Rate for Payer: Humana Medicare Advantage	$15.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.79
Rate for Payer: Wellcare Medicare Advantage	$14.90

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

ETHYLOL 500MG INJ VIAL

Facility

$730.00

Hospital Charge Code	60635371
Hospital Revenue Code	636
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$219.00
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

ETHYLOL 500MG INJ VIAL

Facility

$730.00

Hospital Charge Code	60635371
Hospital Revenue Code	636
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$176.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

ETIDOCAINE 1% PF INJ

Facility

$5.65

Hospital Charge Code	6002356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
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	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

ETIDOCAINE 1% PF INJ

Facility

$5.65

Hospital Charge Code	6002356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

ETIDRONATE 200 MG TAB

Facility

$20.85

Hospital Charge Code	60628528
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.43

ETIDRONATE 200 MG TAB

Facility

$20.85

Hospital Charge Code	60628528
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

ETIDRONATE 300 MG/6ML INJ

Facility

$67.50

Hospital Charge Code	60628529
Hospital Revenue Code	636
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$20.25
Rate for Payer: Aetna Medicare Advantage	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.21
Rate for Payer: Cigna Commercial	$33.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

ETIDRONATE 300 MG/6ML INJ

Facility

$67.50

Hospital Charge Code	60628529
Hospital Revenue Code	636
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

ETIDRONATE 300 MG INJ

Facility

$258.00

Hospital Charge Code	60632838
Hospital Revenue Code	250
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.54
Rate for Payer: Oxford Commercial	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$129.00

ETIDRONATE 300 MG INJ

Facility

$258.00

Hospital Charge Code	60632838
Hospital Revenue Code	250
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

ETIDRONATE DISODIUM INJ 300MG

Facility

$285.45

Hospital Charge Code	6016380
Hospital Revenue Code	636
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$69.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82

ETIDRONATE DISODIUM INJ 300MG

Facility

$285.45

Hospital Charge Code	6016380
Hospital Revenue Code	636
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$142.72
Rate for Payer: Aetna Commercial	$85.64
Rate for Payer: Aetna Medicare Advantage	$85.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.79
Rate for Payer: Cigna Commercial	$142.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.82

ETIDRONATE TAB 400MG

Facility

$30.10

Hospital Charge Code	6002364
Hospital Revenue Code	252
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

ETIDRONATE TAB 400MG

Facility

$30.10

Hospital Charge Code	6002364
Hospital Revenue Code	252
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

ET INTUBATION

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	366831500
Hospital Revenue Code	361
Min. Negotiated Rate	$166.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Better Health Medicaid	$628.17
Rate for Payer: Aetna Commercial	$383.44
Rate for Payer: Aetna Medicare Advantage	$383.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.93
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	$325.93
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.72
Rate for Payer: UnitedHealthcare Commercial	$1,686.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

Know your out-of-pocket cost for care.

All Charges