Heights University Hospital

All Charges

Charge

Type

Setting

Price

INDERAL LA/60MG

Facility

$4.00

Hospital Charge Code	60634811
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

INDERAL LA/60MG

Facility

$4.00

Hospital Charge Code	60634811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INDERAL LA/80MG/CAP

Facility

$5.00

Hospital Charge Code	60633174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

INDERAL LA/80MG/CAP

Facility

$5.00

Hospital Charge Code	60633174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

INDERIDE 40/25/TAB

Facility

$3.00

Hospital Charge Code	60634226
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

INDERIDE 40/25/TAB

Facility

$3.00

Hospital Charge Code	60634226
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

INDERIDE-80/25/TAB

Facility

$6.00

Hospital Charge Code	60633177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

INDERIDE-80/25/TAB

Facility

$6.00

Hospital Charge Code	60633177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

INDERMIL TISSUE ADHESIVE

Facility

$124.00

Hospital Charge Code	60635538
Hospital Revenue Code	636
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.01
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

INDERMIL TISSUE ADHESIVE

Facility

$124.00

Hospital Charge Code	60635538
Hospital Revenue Code	636
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$30.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.01
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

INDIA INK STAIN

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	3009347
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INDIA INK STAIN

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	3009347
Hospital Revenue Code	309
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
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	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

INDIA INK SYRINGE

Facility

$28.80

Hospital Charge Code	60628974
Hospital Revenue Code	251
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

INDIA INK SYRINGE

Facility

$28.80

Hospital Charge Code	60628974
Hospital Revenue Code	251
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$8.64
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$14.40

INDIGO CARMINE 0.8%/5ML

Facility

$118.00

Hospital Charge Code	60633178
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

INDIGO CARMINE 0.8%/5ML

Facility

$118.00

Hospital Charge Code	60633178
Hospital Revenue Code	250
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$59.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$59.00

INDIGO INJ 0.8%

Facility

$60.30

Service Code	NDC 517037510
Hospital Charge Code	60627874
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$30.15
Rate for Payer: Aetna Commercial	$18.09
Rate for Payer: Aetna Medicare Advantage	$18.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.38
Rate for Payer: Cigna Commercial	$30.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Oxford Commercial	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.04
Rate for Payer: UnitedHealthcare Commercial	$30.15

INDIGO INJ 0.8%

Facility

$60.30

Service Code	NDC 517037510
Hospital Charge Code	60627874
Hospital Revenue Code	250
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.04

INDIGO SYSTEM LIGHTING 7

Facility

$28,050.00

Service Code	HCPCS A4649
Hospital Charge Code	270693837S
Hospital Revenue Code	272
Min. Negotiated Rate	$3,646.50
Max. Negotiated Rate	$14,025.00
Rate for Payer: Aetna Commercial	$8,415.00
Rate for Payer: Aetna Medicare Advantage	$8,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,152.75
Rate for Payer: Cigna Commercial	$14,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,646.50
Rate for Payer: Oxford Commercial	$14,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,207.50
Rate for Payer: UnitedHealthcare Commercial	$14,025.00

INDIGO SYSTEM LIGHTING 7

Facility

$28,050.00

Service Code	HCPCS A4649
Hospital Charge Code	270693837S
Hospital Revenue Code	272
Min. Negotiated Rate	$4,207.50
Max. Negotiated Rate	$4,207.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,207.50

INDIGOTINDISUL SOD INJ .8% 5ML

Facility

$41.60

Hospital Charge Code	6003057
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

INDIGOTINDISUL SOD INJ .8% 5ML

Facility

$41.60

Hospital Charge Code	6003057
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

INDINAVIR CAP 400MG

Facility

$10.90

Hospital Charge Code	6016562
Hospital Revenue Code	252
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

INDINAVIR CAP 400MG

Facility

$10.90

Hospital Charge Code	6016562
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

INDINAVIR SULFATE 400 MG CAP

Facility

$20.85

Hospital Charge Code	60628814
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.43

Know your out-of-pocket cost for care.

All Charges