Heights University Hospital

All Charges

Charge

Type

Setting

Price

ET INTUBATION

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	366831500
Hospital Revenue Code	361
Min. Negotiated Rate	$191.72
Max. Negotiated Rate	$191.72
Rate for Payer: Qualcare PPO/HMO/WC	$191.72

ET INTUBATION EMERGENCY PROC

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	7411001
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

ET INTUBATION EMERGENCY PROC

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	7411001
Hospital Revenue Code	361
Min. Negotiated Rate	$191.72
Max. Negotiated Rate	$191.72
Rate for Payer: Qualcare PPO/HMO/WC	$191.72

ETODOLAC 400 MG TAB

Facility

$12.85

Hospital Charge Code	60628616
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.42

ETODOLAC 400 MG TAB

Facility

$12.85

Hospital Charge Code	60628616
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

ETOMIDATE 20 MG/10ML INJ

Facility

$88.84

Service Code	NDC 55390076210
Hospital Charge Code	60628617
Hospital Revenue Code	250
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$44.42
Rate for Payer: Aetna Commercial	$26.65
Rate for Payer: Aetna Medicare Advantage	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.65
Rate for Payer: Cigna Commercial	$44.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.55
Rate for Payer: Oxford Commercial	$44.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.33
Rate for Payer: UnitedHealthcare Commercial	$44.42

ETOMIDATE 20 MG/10ML INJ

Facility

$88.84

Service Code	NDC 55390076210
Hospital Charge Code	60628617
Hospital Revenue Code	250
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$13.33
Rate for Payer: Qualcare PPO/HMO/WC	$13.33

ETOMIDATE 20MG/2ML

Facility

$34.00

Hospital Charge Code	60635365
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

ETOMIDATE 20MG/2ML

Facility

$34.00

Hospital Charge Code	60635365
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

ETOMIDATE 40MG/20ML

Facility

$45.00

Hospital Charge Code	60635366
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

ETOMIDATE 40MG/20ML

Facility

$45.00

Hospital Charge Code	60635366
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

ETOMIDATE INJ 20MG

Facility

$133.80

Hospital Charge Code	6016158
Hospital Revenue Code	250
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.07

ETOMIDATE INJ 20MG

Facility

$133.80

Hospital Charge Code	6016158
Hospital Revenue Code	250
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$66.90
Rate for Payer: Aetna Commercial	$40.14
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.12
Rate for Payer: Cigna Commercial	$66.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.39
Rate for Payer: Oxford Commercial	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$20.07
Rate for Payer: UnitedHealthcare Commercial	$66.90

ETOPOSIDE 100 MG

Facility

$774.00

Hospital Charge Code	60634148
Hospital Revenue Code	636
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$187.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.10

ETOPOSIDE 100 MG

Facility

$774.00

Hospital Charge Code	60634148
Hospital Revenue Code	636
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$232.20
Rate for Payer: Aetna Medicare Advantage	$232.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.37
Rate for Payer: Cigna Commercial	$387.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.10

ETOPOSIDE INJ 10MG

Facility

$15.40

Hospital Charge Code	6017115
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

ETOPOSIDE INJ 10MG

Facility

$15.40

Hospital Charge Code	6017115
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

E TRAP POLYP TRAP

Facility

$30.00

Hospital Charge Code	270657669
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

E TRAP POLYP TRAP

Facility

$30.00

Hospital Charge Code	270657669
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

ETRETINATE CAP 25MG

Facility

$26.90

Hospital Charge Code	60628313
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

ETRETINATE CAP 25MG

Facility

$26.90

Hospital Charge Code	60628313
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$13.45

EUGLOBIN CLOT LYSIS

Facility

$163.40

Service Code	HCPCS 85360
Hospital Charge Code	3007382
Hospital Revenue Code	305
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$24.51
Rate for Payer: Qualcare PPO/HMO/WC	$24.51

EUGLOBIN CLOT LYSIS

Facility

$163.40

Service Code	HCPCS 85360
Hospital Charge Code	3007382
Hospital Revenue Code	305
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.25
Rate for Payer: Aetna Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.81
Rate for Payer: Cigna Commercial	$8.41
Rate for Payer: Cigna Medicare Advantage	$4.21
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.51
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.91
Rate for Payer: Wellcare Medicare Advantage	$8.41

EUGLOBULIN LYSIS

Facility

$59.00

Service Code	HCPCS 85360
Hospital Charge Code	38477055
Hospital Revenue Code	305
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

EUGLOBULIN LYSIS

Facility

$59.00

Service Code	HCPCS 85360
Hospital Charge Code	38477055
Hospital Revenue Code	305
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.25
Rate for Payer: Aetna Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.81
Rate for Payer: Cigna Commercial	$8.41
Rate for Payer: Cigna Medicare Advantage	$4.21
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.91
Rate for Payer: Wellcare Medicare Advantage	$8.41

Know your out-of-pocket cost for care.

All Charges