Heights University Hospital

All Charges

Charge

Type

Setting

Price

ISORDIL TEMBIDS/40MG/TAB

Facility

$3.00

Hospital Charge Code	60634397
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

ISOSORBIDE DINITRATE/10MG

Facility

$3.00

Hospital Charge Code	60633224
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

ISOSORBIDE DINITRATE/10MG

Facility

$3.00

Hospital Charge Code	60633224
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ISOSORBIDE DINITRATE 10 MG TAB

Facility

$7.24

Service Code	NDC 781155601
Hospital Charge Code	60627648
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

ISOSORBIDE DINITRATE 10 MG TAB

Facility

$7.24

Service Code	NDC 781155601
Hospital Charge Code	60627648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

ISOSORBIDE DINITRATE 20 MG TAB

Facility

$7.97

Service Code	NDC 781169513
Hospital Charge Code	60627649
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ISOSORBIDE DINITRATE 20 MG TAB

Facility

$7.97

Service Code	NDC 781169513
Hospital Charge Code	60627649
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$3.98

ISOSORBIDE DINITRATE 30MG

Facility

$8.78

Service Code	NDC 49884000901
Hospital Charge Code	606390328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$4.39
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna Medicare Advantage	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.24
Rate for Payer: Cigna Commercial	$4.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.14
Rate for Payer: Oxford Commercial	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Commercial	$4.39

ISOSORBIDE DINITRATE 30MG

Facility

$8.78

Service Code	NDC 49884000901
Hospital Charge Code	606390328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

ISOSORBIDE DINITRATE 5 MG TAB

Facility

$6.63

Service Code	NDC 68001022300
Hospital Charge Code	6022594
Hospital Revenue Code	251
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

ISOSORBIDE DINITRATE 5 MG TAB

Facility

$6.63

Service Code	NDC 68001022300
Hospital Charge Code	6022594
Hospital Revenue Code	251
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$1.99
Rate for Payer: Aetna Medicare Advantage	$1.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.69
Rate for Payer: Cigna Commercial	$3.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.86
Rate for Payer: Oxford Commercial	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$3.31

ISOSORBIDE DINITRT TAB SR 40MG

Facility

$1.95

Hospital Charge Code	60627650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

ISOSORBIDE DINITRT TAB SR 40MG

Facility

$1.95

Hospital Charge Code	60627650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

ISOSORBIDE MONONIT TAB 10MG

Facility

$4.09

Service Code	NDC 62175010601
Hospital Charge Code	60628630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

ISOSORBIDE MONONIT TAB 10MG

Facility

$4.09

Service Code	NDC 62175010601
Hospital Charge Code	60628630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$2.04
Rate for Payer: Aetna Commercial	$1.23
Rate for Payer: Aetna Medicare Advantage	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.04
Rate for Payer: Cigna Commercial	$2.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.53
Rate for Payer: Oxford Commercial	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.61
Rate for Payer: UnitedHealthcare Commercial	$2.04

ISOSORBIDE MONONIT TAB SR 30MG

Facility

$11.12

Service Code	NDC 904644961
Hospital Charge Code	60627652
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna Medicare Advantage	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.84
Rate for Payer: Cigna Commercial	$5.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$5.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.67
Rate for Payer: UnitedHealthcare Commercial	$5.56

ISOSORBIDE MONONIT TAB SR 30MG

Facility

$11.12

Service Code	NDC 904644961
Hospital Charge Code	60627652
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.67

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna Commercial	$2.71
Rate for Payer: Aetna Medicare Advantage	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.31
Rate for Payer: Cigna Commercial	$4.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.18
Rate for Payer: Oxford Commercial	$4.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.36
Rate for Payer: UnitedHealthcare Commercial	$4.53

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.36

ISOSORBIDE TAB 20MG

Facility

$3.85

Hospital Charge Code	6023139
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

ISOSORBIDE TAB 20MG

Facility

$3.85

Hospital Charge Code	6023139
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

ISOSORBIDE TAB SL 2.5MG

Facility

$3.20

Hospital Charge Code	6022586
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

ISOSORBIDE TAB SL 2.5MG

Facility

$3.20

Hospital Charge Code	6022586
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

Know your out-of-pocket cost for care.

All Charges