Heights University Hospital

All Charges

Charge

Type

Setting

Price

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$184.88
Max. Negotiated Rate	$711.07
Rate for Payer: Aetna Commercial	$426.64
Rate for Payer: Aetna Medicare Advantage	$426.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.65
Rate for Payer: Cigna Commercial	$711.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.88
Rate for Payer: Oxford Commercial	$711.07
Rate for Payer: Qualcare PPO/HMO/WC	$213.32
Rate for Payer: UnitedHealthcare Commercial	$711.07

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$213.32
Max. Negotiated Rate	$213.32
Rate for Payer: Qualcare PPO/HMO/WC	$213.32

ISOSULFAN BLUE 1% 5ML

Facility

$846.00

Hospital Charge Code	60635591
Hospital Revenue Code	250
Min. Negotiated Rate	$109.98
Max. Negotiated Rate	$423.00
Rate for Payer: Aetna Commercial	$253.80
Rate for Payer: Aetna Medicare Advantage	$253.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.73
Rate for Payer: Cigna Commercial	$423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.98
Rate for Payer: Oxford Commercial	$423.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.90
Rate for Payer: UnitedHealthcare Commercial	$423.00

ISOSULFAN BLUE 1% 5ML

Facility

$846.00

Hospital Charge Code	60635591
Hospital Revenue Code	250
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.90

ISOTOCARPINE 3%

Facility

$49.00

Hospital Charge Code	60634900
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

ISOTOCARPINE 3%

Facility

$49.00

Hospital Charge Code	60634900
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$54.35
Max. Negotiated Rate	$54.35
Rate for Payer: Qualcare PPO/HMO/WC	$54.35

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$181.17
Rate for Payer: Aetna Commercial	$108.70
Rate for Payer: Aetna Medicare Advantage	$108.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.40
Rate for Payer: Cigna Commercial	$181.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.10
Rate for Payer: Oxford Commercial	$181.17
Rate for Payer: Qualcare PPO/HMO/WC	$54.35
Rate for Payer: UnitedHealthcare Commercial	$181.17

ISOVUE M200 10ML

Facility

$90.34

Hospital Charge Code	270653684
Hospital Revenue Code	270
Min. Negotiated Rate	$11.74
Max. Negotiated Rate	$45.17
Rate for Payer: Aetna Commercial	$27.10
Rate for Payer: Aetna Medicare Advantage	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.04
Rate for Payer: Cigna Commercial	$45.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.74
Rate for Payer: Oxford Commercial	$45.17
Rate for Payer: Qualcare PPO/HMO/WC	$13.55
Rate for Payer: UnitedHealthcare Commercial	$45.17

ISOVUE M200 10ML

Facility

$90.34

Hospital Charge Code	270653684
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$13.55

ISOVUE MULTIPAC

Facility

$827.92

Hospital Charge Code	60635842
Hospital Revenue Code	255
Min. Negotiated Rate	$107.63
Max. Negotiated Rate	$413.96
Rate for Payer: Aetna Commercial	$248.38
Rate for Payer: Aetna Medicare Advantage	$248.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.12
Rate for Payer: Cigna Commercial	$413.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.63
Rate for Payer: Oxford Commercial	$413.96
Rate for Payer: Qualcare PPO/HMO/WC	$124.19
Rate for Payer: UnitedHealthcare Commercial	$413.96

ISOVUE MULTIPAC

Facility

$827.92

Hospital Charge Code	60635842
Hospital Revenue Code	255
Min. Negotiated Rate	$124.19
Max. Negotiated Rate	$124.19
Rate for Payer: Qualcare PPO/HMO/WC	$124.19

ISRADIPINE 5mg ER

Facility

$3.30

Hospital Charge Code	60629960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

ISRADIPINE 5mg ER

Facility

$3.30

Hospital Charge Code	60629960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: Aetna Commercial	$0.99
Rate for Payer: Aetna Medicare Advantage	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.84
Rate for Payer: Cigna Commercial	$1.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.43
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: UnitedHealthcare Commercial	$1.65

ISRADIPINE CAP 5MG

Facility

$11.15

Hospital Charge Code	60627568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.67

ISRADIPINE CAP 5MG

Facility

$11.15

Hospital Charge Code	60627568
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$5.58
Rate for Payer: Aetna Commercial	$3.35
Rate for Payer: Aetna Medicare Advantage	$3.35
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	$5.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$5.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.67
Rate for Payer: UnitedHealthcare Commercial	$5.58

ISTENT INJECTION

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270687704
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISTENT INJECTION

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270687704
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISTENT INJECT W INSERTER

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270690811
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISTENT INJECT W INSERTER

Facility

$13,625.00

Service Code	HCPCS C1783
Hospital Charge Code	270690811
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$6,812.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$6,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

ISUPREL/0.2MG/1ML

Facility

$640.32

Service Code	NDC 51927429500
Hospital Charge Code	60633225
Hospital Revenue Code	250
Min. Negotiated Rate	$83.24
Max. Negotiated Rate	$320.16
Rate for Payer: Aetna Commercial	$192.10
Rate for Payer: Aetna Medicare Advantage	$192.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.28
Rate for Payer: Cigna Commercial	$320.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.24
Rate for Payer: Oxford Commercial	$320.16
Rate for Payer: Qualcare PPO/HMO/WC	$96.05
Rate for Payer: UnitedHealthcare Commercial	$320.16

ISUPREL/0.2MG/1ML

Facility

$640.32

Service Code	NDC 51927429500
Hospital Charge Code	60633225
Hospital Revenue Code	250
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$96.05
Rate for Payer: Qualcare PPO/HMO/WC	$96.05

ITA PATELLA IMPLANT - BIOMET

Facility

$3,010.00

Hospital Charge Code	270639912
Hospital Revenue Code	278
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$728.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.42
Rate for Payer: Qualcare PPO/HMO/WC	$451.50

ITA PATELLA IMPLANT - BIOMET

Facility

$3,010.00

Hospital Charge Code	270639912
Hospital Revenue Code	278
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$1,505.00
Rate for Payer: Aetna Commercial	$903.00
Rate for Payer: Aetna Medicare Advantage	$903.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$767.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$767.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$767.55
Rate for Payer: Cigna Commercial	$1,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.42
Rate for Payer: Qualcare PPO/HMO/WC	$451.50

ITRACONAZOLE 100 MG CAP

Facility

$44.00

Hospital Charge Code	6016257
Hospital Revenue Code	252
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

Know your out-of-pocket cost for care.

All Charges