Heights University Hospital

All Charges

Charge

Type

Setting

Price

IPPB TREATMENT W/WO MED

Facility

$154.25

Service Code	HCPCS 94664
Hospital Charge Code	9500109
Hospital Revenue Code	410
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$23.14
Rate for Payer: Qualcare PPO/HMO/WC	$23.14

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
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

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IPRATROPIUM BROMIDE/ALBUTEROL

Facility

$1,155.85

Hospital Charge Code	60630186
Hospital Revenue Code	250
Min. Negotiated Rate	$150.26
Max. Negotiated Rate	$577.92
Rate for Payer: Aetna Commercial	$346.75
Rate for Payer: Aetna Medicare Advantage	$346.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.74
Rate for Payer: Cigna Commercial	$577.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.26
Rate for Payer: Oxford Commercial	$577.92
Rate for Payer: Qualcare PPO/HMO/WC	$173.38
Rate for Payer: UnitedHealthcare Commercial	$577.92

IPRATROPIUM BROMIDE/ALBUTEROL

Facility

$1,155.85

Hospital Charge Code	60630186
Hospital Revenue Code	250
Min. Negotiated Rate	$173.38
Max. Negotiated Rate	$173.38
Rate for Payer: Qualcare PPO/HMO/WC	$173.38

IPRATROPIUM BROM INHAL 14GM

Facility

$204.80

Hospital Charge Code	6007132
Hospital Revenue Code	259
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna Commercial	$61.44
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$102.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$102.40

IPRATROPIUM BROM INHAL 14GM

Facility

$204.80

Hospital Charge Code	6007132
Hospital Revenue Code	259
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$313.43
Max. Negotiated Rate	$313.43
Rate for Payer: Qualcare PPO/HMO/WC	$313.43

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$271.64
Max. Negotiated Rate	$1,044.77
Rate for Payer: Aetna Commercial	$626.86
Rate for Payer: Aetna Medicare Advantage	$626.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.83
Rate for Payer: Cigna Commercial	$1,044.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.64
Rate for Payer: Oxford Commercial	$1,044.77
Rate for Payer: Qualcare PPO/HMO/WC	$313.43
Rate for Payer: UnitedHealthcare Commercial	$1,044.77

IPSATOL COUGH SYRUP/4OZ

Facility

$6.00

Hospital Charge Code	60634574
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

IPSATOL COUGH SYRUP/4OZ

Facility

$6.00

Hospital Charge Code	60634574
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$4,000.00

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ABD PARACENTESIS W/IMG

Facility

$4,459.55

Service Code	HCPCS 49083
Hospital Charge Code	2670115
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

IR ABD PARACENTESIS W/IMG

Facility

$2,422.65

Service Code	HCPCS 49083
Hospital Charge Code	7411576
Hospital Revenue Code	361
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$726.79
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.94
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.40
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR ABD PARACENTESIS W/IMG

Facility

$4,459.55

Service Code	HCPCS 49083
Hospital Charge Code	321049083
Hospital Revenue Code	361
Min. Negotiated Rate	$668.93
Max. Negotiated Rate	$668.93
Rate for Payer: Qualcare PPO/HMO/WC	$668.93

IR ABD PARACENTESIS W/IMG

Facility

$4,459.55

Service Code	HCPCS 49083
Hospital Charge Code	321049083
Hospital Revenue Code	361
Min. Negotiated Rate	$579.74
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,337.87
Rate for Payer: Aetna Medicare Advantage	$1,337.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.19
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	$1,137.19
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR ABD PARACENTESIS W/IMG

Facility

$2,422.65

Service Code	HCPCS 49083
Hospital Charge Code	7411576
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

IR ABD PARACENTESIS W/IMG

Facility

$4,459.55

Service Code	HCPCS 49083
Hospital Charge Code	2670115
Hospital Revenue Code	361
Min. Negotiated Rate	$579.74
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,337.87
Rate for Payer: Aetna Medicare Advantage	$1,337.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.19
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	$1,137.19
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

IR ABD PELV VASC SEL CATH ADDL

Facility

$414.45

Service Code	HCPCS 36248
Hospital Charge Code	7411433
Hospital Revenue Code	361
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR ABD PELV VASC SEL CATH ADDL

Facility

$484.00

Service Code	HCPCS 36248
Hospital Charge Code	2004232
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR ABD PELV VASC SEL CATH ADDL

Facility

$484.00

Service Code	HCPCS 36248
Hospital Charge Code	2004232
Hospital Revenue Code	361
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$145.20
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

IR ABD PELV VASC SEL CATH ADDL

Facility

$484.00

Service Code	HCPCS 36248
Hospital Charge Code	321036248
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

Know your out-of-pocket cost for care.

All Charges