Heights University Hospital

All Charges

Charge

Type

Setting

Price

IBUPROFEN 400 MG TAB

Facility

$4.00

Service Code	NDC 63739067210
Hospital Charge Code	6022552
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN 400 MG TAB

Facility

$4.00

Service Code	NDC 63739067210
Hospital Charge Code	6022552
Hospital Revenue Code	251
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

IBUPROFEN 400MG TAB

Facility

$2.00

Hospital Charge Code	83652567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

IBUPROFEN 400MG TAB

Facility

$2.00

Hospital Charge Code	83652567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

IBUPROFEN/600MG

Facility

$3.00

Hospital Charge Code	60634449
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

IBUPROFEN/600MG

Facility

$3.00

Hospital Charge Code	60634449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IBUPROFEN 600 MG TAB

Facility

$4.00

Service Code	NDC 63739068410
Hospital Charge Code	60627683
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

IBUPROFEN 600 MG TAB

Facility

$4.00

Service Code	NDC 63739068410
Hospital Charge Code	60627683
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN/800MG

Facility

$3.00

Hospital Charge Code	60634450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IBUPROFEN/800MG

Facility

$3.00

Hospital Charge Code	60634450
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

IBUPROFEN IV 100 MG/ML INJ

Facility

$105.26

Service Code	HCPCS J1741
Hospital Charge Code	60632224
Hospital Revenue Code	636
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$25.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.47
Rate for Payer: Qualcare PPO/HMO/WC	$15.79

IBUPROFEN IV 100 MG/ML INJ

Facility

$105.26

Service Code	HCPCS J1741
Hospital Charge Code	60632224
Hospital Revenue Code	636
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$31.58
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.84
Rate for Payer: Cigna Commercial	$3.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.47
Rate for Payer: Qualcare PPO/HMO/WC	$15.79

IBUPROFEN (MOTRIN) 800MG TAB

Facility

$4.00

Service Code	NDC 68084077201
Hospital Charge Code	60630134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN (MOTRIN) 800MG TAB

Facility

$4.00

Service Code	NDC 68084077201
Hospital Charge Code	60630134
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

IBUPROFEN SUSP U/D

Facility

$3.00

Hospital Charge Code	60635674
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IBUPROFEN SUSP U/D

Facility

$3.00

Hospital Charge Code	60635674
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

IBUPROFEN TAB 600MG

Facility

$1.95

Hospital Charge Code	6022560
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

IBUPROFEN TAB 600MG

Facility

$1.95

Hospital Charge Code	6022560
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

ICD DEFIB INTERROGATION

Facility

$214.68

Service Code	HCPCS 93289
Hospital Charge Code	74115023
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INTERROGATION

Facility

$6,070.00

Service Code	HCPCS 93289
Hospital Charge Code	94053095
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

ICD DEFIB INTERROGATION

Facility

$214.68

Service Code	HCPCS 93289
Hospital Charge Code	74117023
Hospital Revenue Code	480
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare Advantage	$64.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.74
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

ICD DEFIB INTERROGATION

Facility

$214.68

Service Code	HCPCS 93289
Hospital Charge Code	74116023
Hospital Revenue Code	480
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare Advantage	$64.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.74
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

ICD DEFIB INTERROGATION

Facility

$231.20

Service Code	HCPCS 93289
Hospital Charge Code	5300160
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INTERROGATION

Facility

$214.68

Service Code	HCPCS 93289
Hospital Charge Code	74116023
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

ICD DEFIB INTERROGATION

Facility

$6,070.00

Service Code	HCPCS 93289
Hospital Charge Code	94053095
Hospital Revenue Code	480
Min. Negotiated Rate	$43.02
Max. Negotiated Rate	$1,821.00
Rate for Payer: Aetna Commercial	$1,821.00
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$789.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

Know your out-of-pocket cost for care.

All Charges