Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.20
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: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$1,426.01
Max. Negotiated Rate	$4,753.38
Rate for Payer: Aetna Commercial	$2,852.03
Rate for Payer: Aetna Medicare Advantage	$2,852.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,424.22
Rate for Payer: Cigna Commercial	$4,753.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$1,426.01
Max. Negotiated Rate	$2,300.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$621.90
Rate for Payer: Aetna Medicare Advantage	$621.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.62
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	$528.62
Rate for Payer: Cigna Commercial	$57.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.49
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.95
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$310.95
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

INJ BACLOFEN 2000 MCG/ML

Facility

$1,575.70

Hospital Charge Code	6010094
Hospital Revenue Code	636
Min. Negotiated Rate	$236.35
Max. Negotiated Rate	$787.85
Rate for Payer: Aetna Commercial	$472.71
Rate for Payer: Aetna Medicare Advantage	$472.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.80
Rate for Payer: Cigna Commercial	$787.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.32
Rate for Payer: Qualcare PPO/HMO/WC	$236.35

INJ BACLOFEN 2000 MCG/ML

Facility

$1,575.70

Hospital Charge Code	6010094
Hospital Revenue Code	636
Min. Negotiated Rate	$236.35
Max. Negotiated Rate	$381.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.32
Rate for Payer: Qualcare PPO/HMO/WC	$236.35

INJ CHLOROTHIAZIDE 500 MG

Facility

$46.25

Hospital Charge Code	6001150
Hospital Revenue Code	636
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$11.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

INJ CHLOROTHIAZIDE 500 MG

Facility

$46.25

Hospital Charge Code	6001150
Hospital Revenue Code	636
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

INJDALTEPARIN SODIUM P/2500 IU

Facility

$243.00

Hospital Charge Code	60629252
Hospital Revenue Code	250
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$36.45
Rate for Payer: Qualcare PPO/HMO/WC	$36.45

INJDALTEPARIN SODIUM P/2500 IU

Facility

$243.00

Hospital Charge Code	60629252
Hospital Revenue Code	250
Min. Negotiated Rate	$31.59
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: Aetna Medicare Advantage	$72.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.97
Rate for Payer: Cigna Commercial	$121.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.59
Rate for Payer: Oxford Commercial	$121.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.45
Rate for Payer: UnitedHealthcare Commercial	$121.50

INJ DIPYRIDAMOLE 50MG/10ML

Facility

$401.95

Hospital Charge Code	6009702
Hospital Revenue Code	250
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$60.29

INJ DIPYRIDAMOLE 50MG/10ML

Facility

$401.95

Hospital Charge Code	6009702
Hospital Revenue Code	250
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$200.97
Rate for Payer: Aetna Commercial	$120.58
Rate for Payer: Aetna Medicare Advantage	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.50
Rate for Payer: Cigna Commercial	$200.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.25
Rate for Payer: Oxford Commercial	$200.97
Rate for Payer: Qualcare PPO/HMO/WC	$60.29
Rate for Payer: UnitedHealthcare Commercial	$200.97

INJEC LINE HI PRES 48 91001483

Facility

$13.20

Hospital Charge Code	270632531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$6.60

INJEC LINE HI PRES 48 91001483

Facility

$13.20

Hospital Charge Code	270632531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

INJECT,AMPHOTERICIN B LIP 10MG

Facility

$691.85

Hospital Charge Code	6016571
Hospital Revenue Code	636
Min. Negotiated Rate	$103.78
Max. Negotiated Rate	$167.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$103.78

INJECT,AMPHOTERICIN B LIP 10MG

Facility

$691.85

Hospital Charge Code	6016571
Hospital Revenue Code	636
Min. Negotiated Rate	$103.78
Max. Negotiated Rate	$345.93
Rate for Payer: Aetna Commercial	$207.56
Rate for Payer: Aetna Medicare Advantage	$207.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.42
Rate for Payer: Cigna Commercial	$345.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$103.78

INJECT,DEXAMETHASONE ACETO 1MG

Facility

$9.00

Hospital Charge Code	6012440
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

INJECT,DEXAMETHASONE ACETO 1MG

Facility

$9.00

Hospital Charge Code	6012440
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

INJECT-IM/SQ DURING INFUS

Facility

$343.00

Service Code	HCPCS 9637259
Hospital Charge Code	93500053
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECT-IM/SQ DURING INFUS

Facility

$343.00

Service Code	HCPCS 9637259
Hospital Charge Code	93500053
Hospital Revenue Code	260
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$102.90
Rate for Payer: Aetna Medicare Advantage	$102.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.47
Rate for Payer: Cigna Commercial	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.59
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$802.00

INJECT-INTRA-ART DUR INF

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	93500059
Hospital Revenue Code	260
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

INJECT-INTRA-ART DUR INF

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	3409025
Hospital Revenue Code	260
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$77.10
Rate for Payer: Aetna Medicare Advantage	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.53
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.41
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.55
Rate for Payer: UnitedHealthcare Commercial	$802.00

INJECT-INTRA-ART DUR INF

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	3409025
Hospital Revenue Code	260
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

INJECT-INTRA-ART DUR INF

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	93500059
Hospital Revenue Code	260
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$77.10
Rate for Payer: Aetna Medicare Advantage	$77.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.53
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.41
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.55
Rate for Payer: UnitedHealthcare Commercial	$802.00

Know your out-of-pocket cost for care.

All Charges