Heights University Hospital

All Charges

Charge

Type

Setting

Price

AMINOPHYLLINE INJ 500MG/20ML

Facility

$7.70

Hospital Charge Code	60628471
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

AMINOPHYLLINE LIQ DF 8OZ

Facility

$52.50

Hospital Charge Code	6012215
Hospital Revenue Code	251
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

AMINOPHYLLINE LIQ DF 8OZ

Facility

$52.50

Hospital Charge Code	6012215
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

AMINOPHYLLIN INJ/250MG

Facility

$4.00

Hospital Charge Code	60634284
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMINOPHYLLIN INJ/250MG

Facility

$4.00

Hospital Charge Code	60634284
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$14.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.65

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$12.70
Max. Negotiated Rate	$48.84
Rate for Payer: Aetna Commercial	$29.31
Rate for Payer: Aetna Medicare Advantage	$29.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.91
Rate for Payer: Cigna Commercial	$48.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.70
Rate for Payer: Oxford Commercial	$48.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.65
Rate for Payer: UnitedHealthcare Commercial	$48.84

AMINOSYN 10% 1000ML

Facility

$39.00

Hospital Charge Code	60635449
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

AMINOSYN 10% 1000ML

Facility

$39.00

Hospital Charge Code	60635449
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$19.50

AMINOSYN2 4.25%+10% DEXTR

Facility

$427.00

Hospital Charge Code	60634255
Hospital Revenue Code	250
Min. Negotiated Rate	$55.51
Max. Negotiated Rate	$213.50
Rate for Payer: Aetna Commercial	$128.10
Rate for Payer: Aetna Medicare Advantage	$128.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.89
Rate for Payer: Cigna Commercial	$213.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.51
Rate for Payer: Oxford Commercial	$213.50
Rate for Payer: Qualcare PPO/HMO/WC	$64.05
Rate for Payer: UnitedHealthcare Commercial	$213.50

AMINOSYN2 4.25%+10% DEXTR

Facility

$427.00

Hospital Charge Code	60634255
Hospital Revenue Code	250
Min. Negotiated Rate	$64.05
Max. Negotiated Rate	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$64.05

AMINOSYN2 4.25%+25%/1000C

Facility

$432.00

Hospital Charge Code	60634252
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMINOSYN2 4.25%+25%/1000C

Facility

$432.00

Hospital Charge Code	60634252
Hospital Revenue Code	250
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$129.60
Rate for Payer: Aetna Medicare Advantage	$129.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.16
Rate for Payer: Cigna Commercial	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.16
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.80
Rate for Payer: UnitedHealthcare Commercial	$216.00

AMINOSYN2 4.25%+25%W/LYTE

Facility

$432.00

Hospital Charge Code	60634253
Hospital Revenue Code	250
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

AMINOSYN2 4.25%+25%W/LYTE

Facility

$432.00

Hospital Charge Code	60634253
Hospital Revenue Code	250
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$129.60
Rate for Payer: Aetna Medicare Advantage	$129.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.16
Rate for Payer: Cigna Commercial	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.16
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.80
Rate for Payer: UnitedHealthcare Commercial	$216.00

AMINOSYN 8.5%/500CC

Facility

$237.00

Hospital Charge Code	60634254
Hospital Revenue Code	250
Min. Negotiated Rate	$30.81
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$71.10
Rate for Payer: Aetna Medicare Advantage	$71.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.44
Rate for Payer: Cigna Commercial	$118.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.81
Rate for Payer: Oxford Commercial	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.55
Rate for Payer: UnitedHealthcare Commercial	$118.50

AMINOSYN 8.5%/500CC

Facility

$237.00

Hospital Charge Code	60634254
Hospital Revenue Code	250
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$35.55
Rate for Payer: Qualcare PPO/HMO/WC	$35.55

AMINOSYN II 4.25%+25% DEX

Facility

$1,066.00

Hospital Charge Code	60634543
Hospital Revenue Code	250
Min. Negotiated Rate	$138.58
Max. Negotiated Rate	$533.00
Rate for Payer: Aetna Commercial	$319.80
Rate for Payer: Aetna Medicare Advantage	$319.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.83
Rate for Payer: Cigna Commercial	$533.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.58
Rate for Payer: Oxford Commercial	$533.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.90
Rate for Payer: UnitedHealthcare Commercial	$533.00

AMINOSYN II 4.25%+25% DEX

Facility

$1,066.00

Hospital Charge Code	60634543
Hospital Revenue Code	250
Min. Negotiated Rate	$159.90
Max. Negotiated Rate	$159.90
Rate for Payer: Qualcare PPO/HMO/WC	$159.90

AMINOSYN RF 5.2%/300ML

Facility

$414.00

Hospital Charge Code	60634297
Hospital Revenue Code	250
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Oxford Commercial	$207.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$207.00

AMINOSYN RF 5.2%/300ML

Facility

$414.00

Hospital Charge Code	60634297
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

AMINOSYN-RF 5.2%/300ML

Facility

$293.00

Hospital Charge Code	60632436
Hospital Revenue Code	250
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$87.90
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.09
Rate for Payer: Oxford Commercial	$146.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$146.50

AMINOSYN-RF 5.2%/300ML

Facility

$293.00

Hospital Charge Code	60632436
Hospital Revenue Code	250
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$5.06
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$0.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$4.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

Know your out-of-pocket cost for care.

All Charges