Heights University Hospital

All Charges

Charge

Type

Setting

Price

FERROUS SULFATE/300MG/5ML

Facility

$1.00

Hospital Charge Code	60632982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

FERROUS SULFATE/300MG/5ML

Facility

$3.00

Hospital Charge Code	60632986
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

$1.00

Hospital Charge Code	60632982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

FERROUS SULFATE 325MG EC TAB

Facility

$4.00

Service Code	NDC 46017009712
Hospital Charge Code	60631451
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 325MG EC TAB

Facility

$4.00

Service Code	NDC 46017009712
Hospital Charge Code	60631451
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/325MG/TAB

Facility

$3.00

Hospital Charge Code	60632988
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/325MG/TAB

Facility

$3.00

Hospital Charge Code	60632987
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/325MG/TAB

Facility

$3.00

Hospital Charge Code	60632988
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/325MG/TAB

Facility

$1.00

Hospital Charge Code	60632985
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

FERROUS SULFATE/325MG/TAB

Facility

$1.00

Hospital Charge Code	60632985
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

FERROUS SULFATE/325MG/TAB

Facility

$3.00

Hospital Charge Code	60632987
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 .75/.6ML 50MLD

Facility

$2.45

Hospital Charge Code	6009427
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

FERROUS SULFATE .75/.6ML 50MLD

Facility

$2.45

Hospital Charge Code	6009427
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

FERROUS SULFATE ELX 220MG/5ML

Facility

$2.45

Hospital Charge Code	60627500
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

FERROUS SULFATE ELX 220MG/5ML

Facility

$2.45

Hospital Charge Code	60627500
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

FERROUS SULFATE LQ 300MG/5ML

Facility

$27.27

Service Code	NDC 121053005
Hospital Charge Code	60627501
Hospital Revenue Code	250
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$13.63
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Oxford Commercial	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$13.63

FERROUS SULFATE LQ 300MG/5ML

Facility

$27.27

Service Code	NDC 121053005
Hospital Charge Code	60627501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

FERUMOXYTOL 510MG

Facility

$269.94

Service Code	HCPCS Q0138
Hospital Charge Code	60639603
Hospital Revenue Code	636
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$65.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.49

FERUMOXYTOL 510MG

Facility

$269.94

Service Code	HCPCS Q0138
Hospital Charge Code	60639603
Hospital Revenue Code	636
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$80.98
Rate for Payer: Aetna Commercial	$80.98
Rate for Payer: Aetna Medicare Advantage	$80.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.49

FETAL BIOPH PROF W/NST

Facility

$517.00

Service Code	HCPCS 76818
Hospital Charge Code	94061175
Hospital Revenue Code	402
Min. Negotiated Rate	$67.21
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$155.10
Rate for Payer: Aetna Medicare Advantage	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.84
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

FETAL BIOPH PROF W/NST

Facility

$517.00

Service Code	HCPCS 76818
Hospital Charge Code	94061175
Hospital Revenue Code	402
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

FETAL BIOPHYSICAL WNST

Facility

$1,724.80

Service Code	HCPCS 76818
Hospital Charge Code	83653085
Hospital Revenue Code	402
Min. Negotiated Rate	$113.14
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$517.44
Rate for Payer: Aetna Medicare Advantage	$517.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.82
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.22
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.72
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

FETAL BIOPHYSICAL WNST

Facility

$1,724.80

Service Code	HCPCS 76818
Hospital Charge Code	83653085
Hospital Revenue Code	402
Min. Negotiated Rate	$258.72
Max. Negotiated Rate	$258.72
Rate for Payer: Qualcare PPO/HMO/WC	$258.72

FETAL BIOPHYSICAL WNST EA ADTL

Facility

$1,724.80

Service Code	HCPCS 76818
Hospital Charge Code	74308355
Hospital Revenue Code	402
Min. Negotiated Rate	$113.14
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$517.44
Rate for Payer: Aetna Medicare Advantage	$517.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.82
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.22
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.72
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

FETAL BIOPHYSICAL WNST EA ADTL

Facility

$1,724.80

Service Code	HCPCS 76818
Hospital Charge Code	74308355
Hospital Revenue Code	402
Min. Negotiated Rate	$258.72
Max. Negotiated Rate	$258.72
Rate for Payer: Qualcare PPO/HMO/WC	$258.72

Know your out-of-pocket cost for care.

All Charges