Heights University Hospital

All Charges

Charge

Type

Setting

Price

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.17
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$35.17

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$4,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$4,750.00

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

IODINATED GLYCEROL/30MG/1

Facility

$3.00

Hospital Charge Code	60633189
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IODINATED GLYCEROL/30MG/1

Facility

$3.00

Hospital Charge Code	60633189
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

IODINATED GLYCEROL W/DM/5

Facility

$3.00

Hospital Charge Code	60633190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IODINATED GLYCEROL W/DM/5

Facility

$3.00

Hospital Charge Code	60633190
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

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$137.75
Max. Negotiated Rate	$137.75
Rate for Payer: Qualcare PPO/HMO/WC	$137.75

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$119.38
Max. Negotiated Rate	$459.15
Rate for Payer: Aetna Commercial	$275.49
Rate for Payer: Aetna Medicare Advantage	$275.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.17
Rate for Payer: Cigna Commercial	$459.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.38
Rate for Payer: Oxford Commercial	$459.15
Rate for Payer: Qualcare PPO/HMO/WC	$137.75
Rate for Payer: UnitedHealthcare Commercial	$459.15

IODINE SOLUTION

Facility

$62.10

Hospital Charge Code	6012660
Hospital Revenue Code	251
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

IODINE SOLUTION

Facility

$62.10

Hospital Charge Code	6012660
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

IODIXANOL(VISIP)320/ML 100ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630204
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

IODIXANOL(VISIP)320/ML 100ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630204
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.79
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$153.76
Rate for Payer: Aetna Commercial	$153.76
Rate for Payer: Aetna Medicare Advantage	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.70
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$124.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88

IODIXANOL(VISIP) 320/ML 200ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630206
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.79
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

IODIXANOL(VISIP) 320/ML 200ML

Facility

$5.96

Service Code	HCPCS Q9967
Hospital Charge Code	60630206
Hospital Revenue Code	636
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

IODOFORM PACKING STRIP 1"

Facility

$30.15

Service Code	NDC 8080783300
Hospital Charge Code	6063943114
Hospital Revenue Code	270
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

IODOFORM PACKING STRIP 1"

Facility

$30.15

Service Code	NDC 8080783300
Hospital Charge Code	6063943114
Hospital Revenue Code	270
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.92
Rate for Payer: Oxford Commercial	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$15.07

IODOFORM PACKING STRIP 1/2"

Facility

$25.66

Service Code	NDC 8080783200
Hospital Charge Code	6063943115
Hospital Revenue Code	270
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$3.85

IODOFORM PACKING STRIP 1/2"

Facility

$25.66

Service Code	NDC 8080783200
Hospital Charge Code	6063943115
Hospital Revenue Code	270
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$12.83
Rate for Payer: Aetna Commercial	$7.70
Rate for Payer: Aetna Medicare Advantage	$7.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.54
Rate for Payer: Cigna Commercial	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.34
Rate for Payer: Oxford Commercial	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$3.85
Rate for Payer: UnitedHealthcare Commercial	$12.83

IODOFORM PACKING STRIP 1/4"

Facility

$25.80

Service Code	NDC 8080783100
Hospital Charge Code	6063943116
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna Commercial	$7.74
Rate for Payer: Aetna Medicare Advantage	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.58
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: Oxford Commercial	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.87
Rate for Payer: UnitedHealthcare Commercial	$12.90

IODOFORM PACKING STRIP 1/4"

Facility

$25.80

Service Code	NDC 8080783100
Hospital Charge Code	6063943116
Hospital Revenue Code	270
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.87

IO EXPAND INTERB SYS 10X22MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698134
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$15,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

Know your out-of-pocket cost for care.

All Charges