Heights University Hospital

All Charges

Charge

Type

Setting

Price

ARICEPT 5MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635191
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.50

ARICEPT 5MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635191
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

ARIPIPRAZOL 2 MG TAB

Facility

$85.65

Hospital Charge Code	60630047
Hospital Revenue Code	250
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$12.85
Rate for Payer: Qualcare PPO/HMO/WC	$12.85

ARIPIPRAZOL 2 MG TAB

Facility

$85.65

Hospital Charge Code	60630047
Hospital Revenue Code	250
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$42.83
Rate for Payer: Oxford Commercial	$42.83
Rate for Payer: Aetna Commercial	$25.70
Rate for Payer: Aetna Medicare Advantage	$25.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.84
Rate for Payer: Cigna Commercial	$42.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.85
Rate for Payer: UnitedHealthcare Commercial	$42.83

ARIPIPRAZOLE 10 MG TAB

Facility

$239.06

Service Code	NDC 59148000813
Hospital Charge Code	60629312
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 10 MG TAB

Facility

$239.06

Service Code	NDC 59148000813
Hospital Charge Code	60629312
Hospital Revenue Code	250
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$71.72
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.08
Rate for Payer: Oxford Commercial	$119.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$119.53

ARIPIPRAZOLE 15 MG TAB

Facility

$239.06

Service Code	NDC 59148000913
Hospital Charge Code	60629294
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 15 MG TAB

Facility

$239.06

Service Code	NDC 59148000913
Hospital Charge Code	60629294
Hospital Revenue Code	250
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$71.72
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.08
Rate for Payer: Oxford Commercial	$119.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$119.53

ARIPIPRAZOLE 2MG TAB

Facility

$239.06

Service Code	NDC 59148000613
Hospital Charge Code	60632227
Hospital Revenue Code	250
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$71.72
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.08
Rate for Payer: Oxford Commercial	$119.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$119.53

ARIPIPRAZOLE 2MG TAB

Facility

$239.06

Service Code	NDC 59148000613
Hospital Charge Code	60632227
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 5MG TAB

Facility

$239.06

Service Code	NDC 59148000713
Hospital Charge Code	60630004
Hospital Revenue Code	250
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$71.72
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.08
Rate for Payer: Oxford Commercial	$119.53
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$119.53

ARIPIPRAZOLE 5MG TAB

Facility

$239.06

Service Code	NDC 59148000713
Hospital Charge Code	60630004
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARISTADA 1064MG

Facility

$29,090.80

Service Code	HCPCS J1944
Hospital Charge Code	606390218
Hospital Revenue Code	636
Min. Negotiated Rate	$4,363.62
Max. Negotiated Rate	$7,039.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,039.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,363.62

ARISTADA 1064MG

Facility

$29,090.80

Service Code	HCPCS J1944
Hospital Charge Code	606390218
Hospital Revenue Code	636
Min. Negotiated Rate	$4,363.62
Max. Negotiated Rate	$8,727.24
Rate for Payer: Aetna Commercial	$8,727.24
Rate for Payer: Aetna Medicare Advantage	$8,727.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,418.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,418.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,418.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,039.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,363.62

ARISTADA 441MG

Facility

$12,057.32

Service Code	HCPCS J1944
Hospital Charge Code	606390215
Hospital Revenue Code	636
Min. Negotiated Rate	$1,808.60
Max. Negotiated Rate	$2,917.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.60

ARISTADA 441MG

Facility

$12,057.32

Service Code	HCPCS J1944
Hospital Charge Code	606390215
Hospital Revenue Code	636
Min. Negotiated Rate	$1,808.60
Max. Negotiated Rate	$3,617.20
Rate for Payer: Aetna Commercial	$3,617.20
Rate for Payer: Aetna Medicare Advantage	$3,617.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.60

ARISTADA 662MG

Facility

$18,099.72

Service Code	HCPCS J1944
Hospital Charge Code	606390216
Hospital Revenue Code	636
Min. Negotiated Rate	$2,714.96
Max. Negotiated Rate	$4,380.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,380.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,714.96

ARISTADA 662MG

Facility

$18,099.72

Service Code	HCPCS J1944
Hospital Charge Code	606390216
Hospital Revenue Code	636
Min. Negotiated Rate	$2,714.96
Max. Negotiated Rate	$5,429.92
Rate for Payer: Aetna Commercial	$5,429.92
Rate for Payer: Aetna Medicare Advantage	$5,429.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,615.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,615.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,615.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,380.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,714.96

ARISTADA 882MG

Facility

$24,114.64

Service Code	HCPCS J1944
Hospital Charge Code	606390217
Hospital Revenue Code	636
Min. Negotiated Rate	$3,617.20
Max. Negotiated Rate	$5,835.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,835.74
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.20

ARISTADA 882MG

Facility

$24,114.64

Service Code	HCPCS J1944
Hospital Charge Code	606390217
Hospital Revenue Code	636
Min. Negotiated Rate	$3,617.20
Max. Negotiated Rate	$7,234.39
Rate for Payer: Aetna Commercial	$7,234.39
Rate for Payer: Aetna Medicare Advantage	$7,234.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,149.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,149.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,149.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,835.74
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.20

ARISTADA INITIO 675MG

Facility

$18,455.15

Service Code	HCPCS J1943
Hospital Charge Code	606390214
Hospital Revenue Code	636
Min. Negotiated Rate	$2,768.27
Max. Negotiated Rate	$4,466.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,466.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,768.27

ARISTADA INITIO 675MG

Facility

$18,455.15

Service Code	HCPCS J1943
Hospital Charge Code	606390214
Hospital Revenue Code	636
Min. Negotiated Rate	$2,768.27
Max. Negotiated Rate	$5,536.55
Rate for Payer: Aetna Commercial	$5,536.55
Rate for Payer: Aetna Medicare Advantage	$5,536.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,706.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,706.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,706.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,466.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,768.27

ARISTA HEMOSTAT 1 GRAM

Facility

$407.50

Hospital Charge Code	270687373
Hospital Revenue Code	272
Min. Negotiated Rate	$61.12
Max. Negotiated Rate	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$61.12

ARISTA HEMOSTAT 1 GRAM

Facility

$407.50

Hospital Charge Code	270687373
Hospital Revenue Code	272
Min. Negotiated Rate	$52.98
Max. Negotiated Rate	$203.75
Rate for Payer: Aetna Commercial	$122.25
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.91
Rate for Payer: Cigna Commercial	$203.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.98
Rate for Payer: Oxford Commercial	$203.75
Rate for Payer: Qualcare PPO/HMO/WC	$61.12
Rate for Payer: UnitedHealthcare Commercial	$203.75

ARISTA HEMOSTAT 3 GRAM

Facility

$812.50

Hospital Charge Code	270687374
Hospital Revenue Code	272
Min. Negotiated Rate	$121.88
Max. Negotiated Rate	$121.88
Rate for Payer: Qualcare PPO/HMO/WC	$121.88

Know your out-of-pocket cost for care.

All Charges