Heights University Hospital

All Charges

Charge

Type

Setting

Price

NORTRIPTYLINE 10MG/5ML LIQUID

Facility

$144.00

Hospital Charge Code	60629097
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

NORTRIPTYLINE 10MG/5ML LIQUID

Facility

$144.00

Hospital Charge Code	60629097
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$43.20
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$72.00

NORTRIPTYLINE 10 MG CAP

Facility

$4.00

Service Code	NDC 68084003101
Hospital Charge Code	60627771
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

NORTRIPTYLINE 10 MG CAP

Facility

$4.00

Service Code	NDC 68084003101
Hospital Charge Code	60627771
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NORTRIPTYLINE 25 MG CAP

Facility

$5.90

Service Code	NDC 68084003201
Hospital Charge Code	60627772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.95
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna Medicare Advantage	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.77
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$2.95

NORTRIPTYLINE 25 MG CAP

Facility

$5.90

Service Code	NDC 68084003201
Hospital Charge Code	60627772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

NORTRIPTYLINE 50 MG CAP

Facility

$18.56

Service Code	NDC 51862001701
Hospital Charge Code	60627773
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$9.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$9.28

NORTRIPTYLINE 50 MG CAP

Facility

$18.56

Service Code	NDC 51862001701
Hospital Charge Code	60627773
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

NORTRIPTYLINE (AVENTYL)

Facility

$151.00

Service Code	HCPCS 80335
Hospital Charge Code	38472740
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.30
Rate for Payer: Aetna Medicare Advantage	$45.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.51
Rate for Payer: Cigna Commercial	$75.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

NORTRIPTYLINE (AVENTYL)

Facility

$151.00

Service Code	HCPCS 80335
Hospital Charge Code	38472740
Hospital Revenue Code	301
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

NORTRIPTYLINE (AVENTYL) SERUM

Facility

$116.85

Service Code	HCPCS 80335
Hospital Charge Code	3002002
Hospital Revenue Code	301
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.05
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$114.00

NORTRIPTYLINE (AVENTYL) SERUM

Facility

$116.85

Service Code	HCPCS 80335
Hospital Charge Code	3002002
Hospital Revenue Code	301
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

NORTRIPTYLINE LQ 10MG/5ML

Facility

$433.95

Hospital Charge Code	6009880
Hospital Revenue Code	251
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$216.97
Rate for Payer: Aetna Commercial	$130.19
Rate for Payer: Aetna Medicare Advantage	$130.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.66
Rate for Payer: Cigna Commercial	$216.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.41
Rate for Payer: Oxford Commercial	$216.97
Rate for Payer: Qualcare PPO/HMO/WC	$65.09
Rate for Payer: UnitedHealthcare Commercial	$216.97

NORTRIPTYLINE LQ 10MG/5ML

Facility

$433.95

Hospital Charge Code	6009880
Hospital Revenue Code	251
Min. Negotiated Rate	$65.09
Max. Negotiated Rate	$65.09
Rate for Payer: Qualcare PPO/HMO/WC	$65.09

NORVASC/2.5MG/TAB

Facility

$7.00

Hospital Charge Code	60634907
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

NORVASC/2.5MG/TAB

Facility

$7.00

Hospital Charge Code	60634907
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

NORVERAPAMIL

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472018
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	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
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

NORVERAPAMIL

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472018
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

NORVIR ORAL SOLUTION

Facility

$48.24

Service Code	NDC 74194063
Hospital Charge Code	60635150
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$14.47
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.27
Rate for Payer: Oxford Commercial	$24.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.24
Rate for Payer: UnitedHealthcare Commercial	$24.12

NORVIR ORAL SOLUTION

Facility

$48.24

Service Code	NDC 74194063
Hospital Charge Code	60635150
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.24

NOSECLIP DISP PLASTIC

Facility

$5.65

Hospital Charge Code	270600648
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

NOSECLIP DISP PLASTIC

Facility

$5.65

Hospital Charge Code	270600648
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

NOSECLIP SNUFFER

Facility

$3.02

Hospital Charge Code	270642030
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna Commercial	$0.91
Rate for Payer: Aetna Medicare Advantage	$0.91
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	$1.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.51

NOSECLIP SNUFFER

Facility

$3.02

Hospital Charge Code	270642030
Hospital Revenue Code	270
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NOVAFED A/CAP

Facility

$3.00

Hospital Charge Code	60633554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges