Heights University Hospital

All Charges

Charge

Type

Setting

Price

ALPRAZOLAM TAB 0.5MG

Facility

$7.70

Hospital Charge Code	60620036
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

ALPRAZOLAM TAB 0.5MG

Facility

$7.70

Hospital Charge Code	60620036
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$176.47
Rate for Payer: Aetna Medicare Advantage	$176.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.00
Rate for Payer: Cigna Commercial	$294.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.24
Rate for Payer: UnitedHealthcare Commercial	$114.00

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$88.24
Max. Negotiated Rate	$88.24
Rate for Payer: Qualcare PPO/HMO/WC	$88.24

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
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	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
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

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

ALPROSTADIL 0.5 MG/ML LNJ

Facility

$600.00

Hospital Charge Code	60628746
Hospital Revenue Code	250
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$300.00

ALPROSTADIL 0.5 MG/ML LNJ

Facility

$600.00

Hospital Charge Code	60628746
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ALTACE/1.25MG/TAB

Facility

$4.00

Hospital Charge Code	60634894
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALTACE/1.25MG/TAB

Facility

$4.00

Hospital Charge Code	60634894
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

ALTACE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634895
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

ALTACE/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634895
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTACE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634896
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTACE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634896
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

ALTACE CAPS 10 MG

Facility

$3.00

Hospital Charge Code	60635340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

ALTACE CAPS 10 MG

Facility

$3.00

Hospital Charge Code	60635340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$917.89
Max. Negotiated Rate	$1,835.77
Rate for Payer: Aetna Commercial	$1,835.77
Rate for Payer: Aetna Medicare Advantage	$1,835.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,560.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,560.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,560.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$917.89
Max. Negotiated Rate	$1,480.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89

ALTEPLASE 2MG/2ML

Facility

$289.65

Hospital Charge Code	60628942
Hospital Revenue Code	636
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$86.89
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

ALTEPLASE 2MG/2ML

Facility

$289.65

Hospital Charge Code	60628942
Hospital Revenue Code	636
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$145.89
Max. Negotiated Rate	$235.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$145.89
Max. Negotiated Rate	$291.77
Rate for Payer: Aetna Commercial	$291.77
Rate for Payer: Aetna Medicare Advantage	$291.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$2,161.81
Max. Negotiated Rate	$3,487.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$2,161.81
Max. Negotiated Rate	$4,323.61
Rate for Payer: Aetna Commercial	$4,323.61
Rate for Payer: Aetna Medicare Advantage	$4,323.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,675.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,675.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,675.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81

ALTEPLASE INJ 100MG

Facility

$18,581.80

Hospital Charge Code	6007041
Hospital Revenue Code	636
Min. Negotiated Rate	$2,787.27
Max. Negotiated Rate	$4,496.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,496.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.27

Know your out-of-pocket cost for care.

All Charges