Heights University Hospital

All Charges

Charge

Type

Setting

Price

ISOFLURANE 100 ML LIQ

Facility

$1,310.45

Hospital Charge Code	60627669
Hospital Revenue Code	250
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ISOFLURANE 100 ML LIQ

Facility

$1,310.45

Hospital Charge Code	60627669
Hospital Revenue Code	250
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

ISOFLURANE 100ML-LONG 6+ HOURS

Facility

$685.45

Hospital Charge Code	6007546
Hospital Revenue Code	250
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$102.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.82

ISOFLURANE 100ML-LONG 6+ HOURS

Facility

$685.45

Hospital Charge Code	6007546
Hospital Revenue Code	250
Min. Negotiated Rate	$89.11
Max. Negotiated Rate	$342.73
Rate for Payer: Aetna Commercial	$205.63
Rate for Payer: Aetna Medicare Advantage	$205.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.79
Rate for Payer: Cigna Commercial	$342.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.11
Rate for Payer: Oxford Commercial	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$102.82
Rate for Payer: UnitedHealthcare Commercial	$342.73

ISOFLURANE GAS INTERMD 3-6 HRS

Facility

$344.35

Hospital Charge Code	6010441
Hospital Revenue Code	250
Min. Negotiated Rate	$44.77
Max. Negotiated Rate	$172.18
Rate for Payer: Aetna Commercial	$103.31
Rate for Payer: Aetna Medicare Advantage	$103.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.81
Rate for Payer: Cigna Commercial	$172.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Oxford Commercial	$172.18
Rate for Payer: Qualcare PPO/HMO/WC	$51.65
Rate for Payer: UnitedHealthcare Commercial	$172.18

ISOFLURANE GAS INTERMD 3-6 HRS

Facility

$344.35

Hospital Charge Code	6010441
Hospital Revenue Code	250
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$51.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.65

ISOFLURANE GAS SHORT 0-3 HOURS

Facility

$174.75

Hospital Charge Code	6010458
Hospital Revenue Code	250
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$52.42
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.72
Rate for Payer: Oxford Commercial	$87.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$87.38

ISOFLURANE GAS SHORT 0-3 HOURS

Facility

$174.75

Hospital Charge Code	6010458
Hospital Revenue Code	250
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$22.99
Max. Negotiated Rate	$88.44
Rate for Payer: Aetna Commercial	$53.06
Rate for Payer: Aetna Medicare Advantage	$53.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$88.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.99
Rate for Payer: Oxford Commercial	$88.44
Rate for Payer: Qualcare PPO/HMO/WC	$26.53
Rate for Payer: UnitedHealthcare Commercial	$88.44

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$26.53
Max. Negotiated Rate	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$26.53

ISOFLURANE SOLUTION 100 ML

Facility

$21.80

Hospital Charge Code	60629264
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

ISOFLURANE SOLUTION 100 ML

Facility

$21.80

Hospital Charge Code	60629264
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$10.90
Rate for Payer: Aetna Commercial	$6.54
Rate for Payer: Aetna Medicare Advantage	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.56
Rate for Payer: Cigna Commercial	$10.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.83
Rate for Payer: Oxford Commercial	$10.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$10.90

ISOFORANE

Facility

$946.60

Hospital Charge Code	6009708
Hospital Revenue Code	250
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$473.30
Rate for Payer: Aetna Commercial	$283.98
Rate for Payer: Aetna Medicare Advantage	$283.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.38
Rate for Payer: Cigna Commercial	$473.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.06
Rate for Payer: Oxford Commercial	$473.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.99
Rate for Payer: UnitedHealthcare Commercial	$473.30

ISOFORANE

Facility

$946.60

Hospital Charge Code	6009708
Hospital Revenue Code	250
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$141.99
Rate for Payer: Qualcare PPO/HMO/WC	$141.99

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOLATION/EXTRACTION OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38472802
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOLATION/EXTRACTION OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38472802
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACT OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479422
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACT OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479422
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.70
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOLATION NUCLEIC ACID, EACH

Facility

$111.00

Hospital Charge Code	3004166A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

ISOLATION NUCLEIC ACID, EACH

Facility

$111.00

Hospital Charge Code	3004166A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOLYSER LTS MULTI-DOSE 22oz

Facility

$37.52

Hospital Charge Code	270650134
Hospital Revenue Code	270
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$18.76
Rate for Payer: Aetna Commercial	$11.26
Rate for Payer: Aetna Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.57
Rate for Payer: Cigna Commercial	$18.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$18.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.63
Rate for Payer: UnitedHealthcare Commercial	$18.76

ISOLYSER LTS MULTI-DOSE 22oz

Facility

$37.52

Hospital Charge Code	270650134
Hospital Revenue Code	270
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$5.63

ISOLYTE H 5% D****

Facility

$20.00

Hospital Charge Code	7000268
Hospital Revenue Code	258
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

Know your out-of-pocket cost for care.

All Charges