Heights University Hospital

All Charges

Charge

Type

Setting

Price

FERRITIN

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	8200310RS
Hospital Revenue Code	301
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$95.32
Rate for Payer: Qualcare PPO/HMO/WC	$95.32

FERRITIN

Facility

$491.40

Service Code	HCPCS 82728
Hospital Charge Code	38472278
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$12.95
Rate for Payer: EmblemHealth Commercial	$40.89
Rate for Payer: Humana Medicare Advantage	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.71
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.45
Rate for Payer: Wellcare Medicare Advantage	$13.63

FERRITIN

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	39900412
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$12.95
Rate for Payer: EmblemHealth Commercial	$40.89
Rate for Payer: Humana Medicare Advantage	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.32
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.45
Rate for Payer: Wellcare Medicare Advantage	$13.63

FERRITIN

Facility

$1,087.80

Service Code	HCPCS 82728
Hospital Charge Code	39888004
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$163.17
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$12.95
Rate for Payer: EmblemHealth Commercial	$40.89
Rate for Payer: Humana Medicare Advantage	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.17
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.45
Rate for Payer: Wellcare Medicare Advantage	$13.63

FERRITIN

Facility

$491.40

Service Code	HCPCS 82728
Hospital Charge Code	38472278
Hospital Revenue Code	301
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$73.71
Rate for Payer: Qualcare PPO/HMO/WC	$73.71

FERRITIN

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	8200310RS
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$12.95
Rate for Payer: EmblemHealth Commercial	$40.89
Rate for Payer: Humana Medicare Advantage	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.32
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.45
Rate for Payer: Wellcare Medicare Advantage	$13.63

FERRITIN

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	39900412
Hospital Revenue Code	301
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$95.32
Rate for Payer: Qualcare PPO/HMO/WC	$95.32

FERRITIN

Facility

$1,087.80

Service Code	HCPCS 82728
Hospital Charge Code	39888004
Hospital Revenue Code	301
Min. Negotiated Rate	$163.17
Max. Negotiated Rate	$163.17
Rate for Payer: Qualcare PPO/HMO/WC	$163.17

FERRITIN, SERUM

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	3004264
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.16
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$12.95
Rate for Payer: EmblemHealth Commercial	$40.89
Rate for Payer: Humana Medicare Advantage	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.32
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.45
Rate for Payer: Wellcare Medicare Advantage	$13.63

FERRITIN, SERUM

Facility

$635.48

Service Code	HCPCS 82728
Hospital Charge Code	3004264
Hospital Revenue Code	301
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$95.32
Rate for Payer: Qualcare PPO/HMO/WC	$95.32

FERRLICIT INJ 62.5/5ML

Facility

$255.67

Service Code	HCPCS J2916
Hospital Charge Code	60635333
Hospital Revenue Code	636
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$61.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.87
Rate for Payer: Qualcare PPO/HMO/WC	$38.35

FERRLICIT INJ 62.5/5ML

Facility

$255.67

Service Code	HCPCS J2916
Hospital Charge Code	60635333
Hospital Revenue Code	636
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$76.70
Rate for Payer: Aetna Commercial	$76.70
Rate for Payer: Aetna Medicare Advantage	$76.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.20
Rate for Payer: Cigna Commercial	$2.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.87
Rate for Payer: Qualcare PPO/HMO/WC	$38.35

FERROUS GLUCONATE TAB 325MG

Facility

$4.00

Service Code	NDC 574050811
Hospital Charge Code	60627499
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

FERROUS GLUCONATE TAB 325MG

Facility

$4.00

Service Code	NDC 574050811
Hospital Charge Code	60627499
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FERROUS SUBSULFATE SOL

Facility

$106.90

Hospital Charge Code	6012553
Hospital Revenue Code	251
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

FERROUS SUBSULFATE SOL

Facility

$106.90

Hospital Charge Code	6012553
Hospital Revenue Code	251
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$53.45
Rate for Payer: Aetna Commercial	$32.07
Rate for Payer: Aetna Medicare Advantage	$32.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.26
Rate for Payer: Cigna Commercial	$53.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Oxford Commercial	$53.45
Rate for Payer: Qualcare PPO/HMO/WC	$16.04
Rate for Payer: UnitedHealthcare Commercial	$53.45

FERROUS SULFATE/150MG/1CA

Facility

$3.00

Hospital Charge Code	60632983
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

FERROUS SULFATE/150MG/1CA

Facility

$3.00

Hospital Charge Code	60632983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FERROUS SULFATE 15MG/ML DROPS

Facility

$4.00

Service Code	NDC 39328005750
Hospital Charge Code	606390132
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

FERROUS SULFATE 15MG/ML DROPS

Facility

$4.00

Service Code	NDC 39328005750
Hospital Charge Code	606390132
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FERROUS SULFATE 220 MG/5 ML ML

Facility

$4.00

Service Code	NDC 50383077816
Hospital Charge Code	6063943200
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

FERROUS SULFATE 220 MG/5 ML ML

Facility

$4.00

Service Code	NDC 50383077816
Hospital Charge Code	6063943200
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FERROUS SULFATE/250MG/1CA

Facility

$3.00

Hospital Charge Code	60632984
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FERROUS SULFATE/250MG/1CA

Facility

$3.00

Hospital Charge Code	60632984
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

FERROUS SULFATE/300MG/5ML

Facility

$3.00

Hospital Charge Code	60632986
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges