Heights University Hospital

All Charges

Charge

Type

Setting

Price

EZETIMIBE-VASTATIN 10-20MG TAB

Facility

$14.80

Hospital Charge Code	60629940
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$4.44
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$7.40

EZETIMIBE-VASTATIN 10-40MG TAB

Facility

$14.80

Hospital Charge Code	60629941
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$4.44
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$7.40

EZETIMIBE-VASTATIN 10-40MG TAB

Facility

$14.80

Hospital Charge Code	60629941
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

EZETIMIBE-VASTATIN 10-80MG TAB

Facility

$14.80

Hospital Charge Code	60629942
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$4.44
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$7.40

EZETIMIBE-VASTATIN 10-80MG TAB

Facility

$14.80

Hospital Charge Code	60629942
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

E-Z GAS II

Facility

$11.34

Hospital Charge Code	60635824
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.70

E-Z GAS II

Facility

$11.34

Hospital Charge Code	60635824
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$5.67
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna Medicare Advantage	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.89
Rate for Payer: Cigna Commercial	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.47
Rate for Payer: Oxford Commercial	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.70
Rate for Payer: UnitedHealthcare Commercial	$5.67

E-Z GAS II GRANULES

Facility

$18.96

Service Code	NDC 10361079301
Hospital Charge Code	606380028
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$5.69
Rate for Payer: Aetna Medicare Advantage	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.83
Rate for Payer: Cigna Commercial	$9.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.46
Rate for Payer: Oxford Commercial	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.84
Rate for Payer: UnitedHealthcare Commercial	$9.48

E-Z GAS II GRANULES

Facility

$18.96

Service Code	NDC 10361079301
Hospital Charge Code	606380028
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.84

E-Z HD 98%

Facility

$45.16

Service Code	NDC 32909076401
Hospital Charge Code	60635822
Hospital Revenue Code	250
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$6.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.77

E-Z HD 98%

Facility

$45.16

Service Code	NDC 32909076401
Hospital Charge Code	60635822
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$22.58
Rate for Payer: Aetna Commercial	$13.55
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.52
Rate for Payer: Cigna Commercial	$22.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.87
Rate for Payer: Oxford Commercial	$22.58
Rate for Payer: Qualcare PPO/HMO/WC	$6.77
Rate for Payer: UnitedHealthcare Commercial	$22.58

EZ-M READY CAT 450ml

Facility

$20.56

Hospital Charge Code	270600436
Hospital Revenue Code	270
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$10.28
Rate for Payer: Aetna Commercial	$6.17
Rate for Payer: Aetna Medicare Advantage	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.24
Rate for Payer: Cigna Commercial	$10.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$10.28
Rate for Payer: Qualcare PPO/HMO/WC	$3.08
Rate for Payer: UnitedHealthcare Commercial	$10.28

EZ-M READY CAT 450ml

Facility

$20.56

Hospital Charge Code	270600436
Hospital Revenue Code	270
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
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

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$12,000.00
Max. Negotiated Rate	$40,000.00
Rate for Payer: Aetna Commercial	$24,000.00
Rate for Payer: Aetna Medicare Advantage	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,400.00
Rate for Payer: Cigna Commercial	$40,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$12,000.00
Max. Negotiated Rate	$19,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00

F3D-C2 STAND ALONE CERVICAL 7M

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

F3D-C2 STAND ALONE CERVICAL 7M

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270706211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$4,665.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$4,312.50
Max. Negotiated Rate	$6,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$4,312.50
Max. Negotiated Rate	$14,375.00
Rate for Payer: Aetna Commercial	$8,625.00
Rate for Payer: Aetna Medicare Advantage	$8,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,331.25
Rate for Payer: Cigna Commercial	$14,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$33.88
Rate for Payer: Aetna Medicare Advantage	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.68
Rate for Payer: Oxford Commercial	$56.48
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$56.48

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$167.05
Max. Negotiated Rate	$642.50
Rate for Payer: Aetna Commercial	$385.50
Rate for Payer: Aetna Medicare Advantage	$385.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.68
Rate for Payer: Cigna Commercial	$642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.05
Rate for Payer: Oxford Commercial	$642.50
Rate for Payer: Qualcare PPO/HMO/WC	$192.75
Rate for Payer: UnitedHealthcare Commercial	$642.50

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$192.75
Max. Negotiated Rate	$192.75
Rate for Payer: Qualcare PPO/HMO/WC	$192.75

Know your out-of-pocket cost for care.

All Charges