Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSULIN INSTRUCT F/U PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200020
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN LENT HUM 10ML 100U/ML

Facility

$12.80

Hospital Charge Code	6003073
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

INSULIN LENT HUM 10ML 100U/ML

Facility

$12.80

Hospital Charge Code	6003073
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

INSULIN LIKE GROWTH FACTOR BP3

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001670
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

INSULIN LIKE GROWTH FACTOR BP3

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3001670
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

INSULIN LISPRO 100u/ml MED COV

Facility

$256.00

Hospital Charge Code	60629885
Hospital Revenue Code	250
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

INSULIN LISPRO 100u/ml MED COV

Facility

$256.00

Hospital Charge Code	60629885
Hospital Revenue Code	250
Min. Negotiated Rate	$33.28
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$76.80
Rate for Payer: Aetna Medicare Advantage	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.28
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$128.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$128.00

INSULIN LISPRO HUGH COVERAGE

Facility

$256.00

Hospital Charge Code	60629887
Hospital Revenue Code	250
Min. Negotiated Rate	$33.28
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna Commercial	$76.80
Rate for Payer: Aetna Medicare Advantage	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.28
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$128.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$128.00

INSULIN LISPRO HUGH COVERAGE

Facility

$256.00

Hospital Charge Code	60629887
Hospital Revenue Code	250
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

INSULIN LISPRO INJ 75%/25%U100

Facility

$37.80

Hospital Charge Code	60629116
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

INSULIN LISPRO INJ 75%/25%U100

Facility

$37.80

Hospital Charge Code	60629116
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$37.82
Max. Negotiated Rate	$145.46
Rate for Payer: Aetna Commercial	$87.27
Rate for Payer: Aetna Medicare Advantage	$87.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.18
Rate for Payer: Cigna Commercial	$145.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.82
Rate for Payer: Oxford Commercial	$145.46
Rate for Payer: Qualcare PPO/HMO/WC	$43.64
Rate for Payer: UnitedHealthcare Commercial	$145.46

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$43.64
Max. Negotiated Rate	$43.64
Rate for Payer: Qualcare PPO/HMO/WC	$43.64

INSULIN PUR PORK NPH INJ U-100

Facility

$215.05

Hospital Charge Code	60628227
Hospital Revenue Code	250
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

INSULIN PUR PORK NPH INJ U-100

Facility

$215.05

Hospital Charge Code	60628227
Hospital Revenue Code	250
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$64.52
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.96
Rate for Payer: Oxford Commercial	$107.53
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$107.53

INSULIN PUR PORK REG INJ U-100

Facility

$336.05

Hospital Charge Code	60628228
Hospital Revenue Code	250
Min. Negotiated Rate	$43.69
Max. Negotiated Rate	$168.03
Rate for Payer: Aetna Commercial	$100.81
Rate for Payer: Aetna Medicare Advantage	$100.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.69
Rate for Payer: Cigna Commercial	$168.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.69
Rate for Payer: Oxford Commercial	$168.03
Rate for Payer: Qualcare PPO/HMO/WC	$50.41
Rate for Payer: UnitedHealthcare Commercial	$168.03

INSULIN PUR PORK REG INJ U-100

Facility

$336.05

Hospital Charge Code	60628228
Hospital Revenue Code	250
Min. Negotiated Rate	$50.41
Max. Negotiated Rate	$50.41
Rate for Payer: Qualcare PPO/HMO/WC	$50.41

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$132.29
Rate for Payer: Aetna Commercial	$79.37
Rate for Payer: Aetna Medicare Advantage	$79.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.47
Rate for Payer: Cigna Commercial	$132.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.40
Rate for Payer: Oxford Commercial	$132.29
Rate for Payer: Qualcare PPO/HMO/WC	$39.69
Rate for Payer: UnitedHealthcare Commercial	$132.29

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$39.69

INSULIN REG HUM 100U/ML 10ML

Facility

$12.80

Hospital Charge Code	6003099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

INSULIN REG HUM 100U/ML 10ML

Facility

$12.80

Hospital Charge Code	6003099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

Know your out-of-pocket cost for care.

All Charges