Heights University Hospital

All Charges

Charge

Type

Setting

Price

LABEL ALLERGIESDRUG 2.5 X 2.5

Facility

$997.50

Hospital Charge Code	270653923
Hospital Revenue Code	272
Min. Negotiated Rate	$129.68
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$299.25
Rate for Payer: Aetna Medicare Advantage	$299.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.36
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.68
Rate for Payer: Oxford Commercial	$498.75
Rate for Payer: Qualcare PPO/HMO/WC	$149.62
Rate for Payer: UnitedHealthcare Commercial	$498.75

LABEL ALLERGIESDRUG 2.5 X 2.5

Facility

$997.50

Hospital Charge Code	270653923
Hospital Revenue Code	272
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$149.62
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

LABEL ID BRACELET

Facility

$900.00

Hospital Charge Code	270653679
Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$450.00

LABEL ID BRACELET

Facility

$900.00

Hospital Charge Code	270653679
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

LABEL PHARMACY

Facility

$563.05

Hospital Charge Code	270652611
Hospital Revenue Code	272
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$84.46
Rate for Payer: Qualcare PPO/HMO/WC	$84.46

LABEL PHARMACY

Facility

$563.05

Hospital Charge Code	270652611
Hospital Revenue Code	272
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$281.52
Rate for Payer: Aetna Commercial	$168.91
Rate for Payer: Aetna Medicare Advantage	$168.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.58
Rate for Payer: Cigna Commercial	$281.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Oxford Commercial	$281.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.46
Rate for Payer: UnitedHealthcare Commercial	$281.52

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna Medicare Advantage	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$5.26
Rate for Payer: Qualcare PPO/HMO/WC	$1.58
Rate for Payer: UnitedHealthcare Commercial	$5.26

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.58

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$12.06
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$20.10

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
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

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna Commercial	$1.37
Rate for Payer: Aetna Medicare Advantage	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.28

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

LABETALOL VIAL

Facility

$90.90

Hospital Charge Code	6012710
Hospital Revenue Code	250
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$45.45

LABETALOL VIAL

Facility

$90.90

Hospital Charge Code	6012710
Hospital Revenue Code	250
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

LABETOLOL 40MG/8ML SDV

Facility

$13.00

Hospital Charge Code	60635509
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

LABETOLOL 40MG/8ML SDV

Facility

$13.00

Hospital Charge Code	60635509
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LABLE NEOSYNEHPRINE

Facility

$26.15

Hospital Charge Code	270660233
Hospital Revenue Code	270
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.92

LABLE NEOSYNEHPRINE

Facility

$26.15

Hospital Charge Code	270660233
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$13.07
Rate for Payer: Aetna Commercial	$7.84
Rate for Payer: Aetna Medicare Advantage	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.67
Rate for Payer: Cigna Commercial	$13.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.40
Rate for Payer: Oxford Commercial	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.92
Rate for Payer: UnitedHealthcare Commercial	$13.07

LAB MISC REF TEST LEVEL 1

Facility

$304.00

Hospital Charge Code	3035010
Hospital Revenue Code	300
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

LAB MISC REF TEST LEVEL 1

Facility

$304.00

Hospital Charge Code	3035010
Hospital Revenue Code	300
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$152.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.52
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

LAB MISC REF TEST LEVEL 2

Facility

$480.00

Hospital Charge Code	3035011
Hospital Revenue Code	300
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

LAB MISC REF TEST LEVEL 2

Facility

$480.00

Hospital Charge Code	3035011
Hospital Revenue Code	300
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

LAB MISC REF TEST LEVEL 3

Facility

$1,200.00

Hospital Charge Code	3035012
Hospital Revenue Code	300
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Know your out-of-pocket cost for care.

All Charges