Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMDUR 30

Facility

$4.00

Hospital Charge Code	60635096
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

IMDUR 30

Facility

$4.00

Hospital Charge Code	60635096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IMDUR/60MG/TAB

Facility

$4.00

Hospital Charge Code	60634941
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IMDUR/60MG/TAB

Facility

$4.00

Hospital Charge Code	60634941
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

IMFERON/50MG/1ML

Facility

$711.00

Hospital Charge Code	60633157
Hospital Revenue Code	250
Min. Negotiated Rate	$106.65
Max. Negotiated Rate	$106.65
Rate for Payer: Qualcare PPO/HMO/WC	$106.65

IMFERON/50MG/1ML

Facility

$711.00

Hospital Charge Code	60633157
Hospital Revenue Code	250
Min. Negotiated Rate	$92.43
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna Commercial	$213.30
Rate for Payer: Aetna Medicare Advantage	$213.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.31
Rate for Payer: Cigna Commercial	$355.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.43
Rate for Payer: Oxford Commercial	$355.50
Rate for Payer: Qualcare PPO/HMO/WC	$106.65
Rate for Payer: UnitedHealthcare Commercial	$355.50

IMFERON 50MG/CC

Facility

$109.45

Hospital Charge Code	6010128
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

IMFERON 50MG/CC

Facility

$109.45

Hospital Charge Code	6010128
Hospital Revenue Code	250
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

IMF SCREW 2MM SELFDRILLING12MM

Facility

$182.10

Hospital Charge Code	270628798
Hospital Revenue Code	278
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$44.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: Qualcare PPO/HMO/WC	$27.32

IMF SCREW 2MM SELFDRILLING12MM

Facility

$182.10

Hospital Charge Code	270628798
Hospital Revenue Code	278
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$91.05
Rate for Payer: Aetna Commercial	$54.63
Rate for Payer: Aetna Medicare Advantage	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.44
Rate for Payer: Cigna Commercial	$91.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.07
Rate for Payer: Qualcare PPO/HMO/WC	$27.32

IMF SCREW 2MM SELFDRILLING 8MM

Facility

$134.00

Hospital Charge Code	270628799
Hospital Revenue Code	278
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$32.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.43
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

IMF SCREW 2MM SELFDRILLING 8MM

Facility

$134.00

Hospital Charge Code	270628799
Hospital Revenue Code	278
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$40.20
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.43
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM INS BREAST PROSTH S/P M

Facility

$42,601.70

Service Code	HCPCS 19340
Hospital Charge Code	16000665
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

IM INS BREAST PROSTH S/P M

Facility

$42,601.70

Service Code	HCPCS 19340
Hospital Charge Code	16000665
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$19,464.07
Rate for Payer: Aetna Commercial	$12,780.51
Rate for Payer: Aetna Medicare Advantage	$12,780.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,863.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,863.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,863.43
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,538.22
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

IMIPEN4MG/CILAST4MG/RELEBAC2MG

Facility

$1,846.05

Service Code	HCPCS J0742
Hospital Charge Code	606390434
Hospital Revenue Code	636
Min. Negotiated Rate	$276.91
Max. Negotiated Rate	$446.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.74
Rate for Payer: Qualcare PPO/HMO/WC	$276.91

IMIPEN4MG/CILAST4MG/RELEBAC2MG

Facility

$1,846.05

Service Code	HCPCS J0742
Hospital Charge Code	606390434
Hospital Revenue Code	636
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$553.82
Rate for Payer: Aetna Commercial	$553.82
Rate for Payer: Aetna Medicare Advantage	$553.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$470.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$470.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$470.74
Rate for Payer: Cigna Commercial	$2.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.74
Rate for Payer: Qualcare PPO/HMO/WC	$276.91

IMIPRAMINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633159
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IMIPRAMINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633158
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

IMIPRAMINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633159
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

IMIPRAMINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IMIPRAMINE 50 MG TAB

Facility

$7.03

Hospital Charge Code	6063943207
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

Know your out-of-pocket cost for care.

All Charges