Heights University Hospital

All Charges

Charge

Type

Setting

Price

ISOLYTE H 5% D****

Facility

$20.00

Hospital Charge Code	7000268
Hospital Revenue Code	258
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

ISOLYTE S 5% D*****

Facility

$22.00

Hospital Charge Code	7000250
Hospital Revenue Code	258
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$11.00

ISOLYTE S 5% D*****

Facility

$22.00

Hospital Charge Code	7000250
Hospital Revenue Code	258
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

ISONIAZID

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	3009823
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ISONIAZID

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	3009823
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

ISONIAZID 300 MG TAB

Facility

$8.64

Service Code	NDC 51079008320
Hospital Charge Code	60628629
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$4.32

ISONIAZID 300 MG TAB

Facility

$8.64

Service Code	NDC 51079008320
Hospital Charge Code	60628629
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

ISONIAZID/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633194
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

ISONIAZID/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633195
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ISONIAZID/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633195
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

ISONIAZID/300MG/TAB

Facility

$4.00

Hospital Charge Code	60633194
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ISONIAZIDE SYRUP/16OZ

Facility

$33.30

Service Code	NDC 46287000901
Hospital Charge Code	60634575
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

ISONIAZIDE SYRUP/16OZ

Facility

$33.30

Service Code	NDC 46287000901
Hospital Charge Code	60634575
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$9.99
Rate for Payer: Aetna Medicare Advantage	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.49
Rate for Payer: Cigna Commercial	$16.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$16.65

ISONIAZID TAB 100MG

Facility

$4.00

Service Code	NDC 555006602
Hospital Charge Code	60628628
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

ISONIAZID TAB 100MG

Facility

$4.00

Service Code	NDC 555006602
Hospital Charge Code	60628628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ISONIAZIO INJ 100MG/1ML 10ML

Facility

$2,358.80

Service Code	NDC 781305670
Hospital Charge Code	60628844
Hospital Revenue Code	250
Min. Negotiated Rate	$353.82
Max. Negotiated Rate	$353.82
Rate for Payer: Qualcare PPO/HMO/WC	$353.82

ISONIAZIO INJ 100MG/1ML 10ML

Facility

$2,358.80

Service Code	NDC 781305670
Hospital Charge Code	60628844
Hospital Revenue Code	250
Min. Negotiated Rate	$306.64
Max. Negotiated Rate	$1,179.40
Rate for Payer: Aetna Commercial	$707.64
Rate for Payer: Aetna Medicare Advantage	$707.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$601.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$601.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$601.49
Rate for Payer: Cigna Commercial	$1,179.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.64
Rate for Payer: Oxford Commercial	$1,179.40
Rate for Payer: Qualcare PPO/HMO/WC	$353.82
Rate for Payer: UnitedHealthcare Commercial	$1,179.40

ISO OR EXTC OF HIGH PURI NUCLE

Facility

$8.00

Service Code	HCPCS 83891
Hospital Charge Code	3035164
Hospital Revenue Code	301
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ISO OR EXTC OF HIGH PURI NUCLE

Facility

$8.00

Service Code	HCPCS 83891
Hospital Charge Code	3035164
Hospital Revenue Code	301
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOPROPANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3037072
Hospital Revenue Code	306
Min. Negotiated Rate	$86.79
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$200.28
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00

ISOPROPANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3037072
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ISOPROPYL ALCOHOL 70%

Facility

$7.64

Service Code	NDC 869081043
Hospital Charge Code	6063943120
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

ISOPROPYL ALCOHOL 70%

Facility

$7.64

Service Code	NDC 869081043
Hospital Charge Code	6063943120
Hospital Revenue Code	270
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$3.82

ISOPROPYL ALCOHOL 70% 473ML

Facility

$9.00

Hospital Charge Code	60628314
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

ISOPROPYL ALCOHOL 70% 473ML

Facility

$9.00

Hospital Charge Code	60628314
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

Know your out-of-pocket cost for care.

All Charges