Heights University Hospital

All Charges

Charge

Type

Setting

Price

PANTOPTAZOLE 40MG TABLET EC

Facility

$67.13

Service Code	NDC 8060701
Hospital Charge Code	60629236
Hospital Revenue Code	250
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Commercial	$20.14
Rate for Payer: Aetna Medicare Advantage	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.12
Rate for Payer: Cigna Commercial	$33.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.73
Rate for Payer: Oxford Commercial	$33.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.07
Rate for Payer: UnitedHealthcare Commercial	$33.56

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658875
Hospital Revenue Code	270
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

PANT SCRUB REV MISTY ENCORE

Facility

$25.10

Hospital Charge Code	270658872
Hospital Revenue Code	270
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$12.55
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: Aetna Medicare Advantage	$7.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.40
Rate for Payer: Cigna Commercial	$12.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.26
Rate for Payer: Oxford Commercial	$12.55
Rate for Payer: Qualcare PPO/HMO/WC	$3.77
Rate for Payer: UnitedHealthcare Commercial	$12.55

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658875
Hospital Revenue Code	270
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.07
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: Aetna Medicare Advantage	$7.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.16
Rate for Payer: Cigna Commercial	$12.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.07

PANT SCRUB REV MISTY ENCORE

Facility

$31.10

Hospital Charge Code	270658873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$15.55
Rate for Payer: Aetna Commercial	$9.33
Rate for Payer: Aetna Medicare Advantage	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.93
Rate for Payer: Cigna Commercial	$15.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.04
Rate for Payer: Oxford Commercial	$15.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.67
Rate for Payer: UnitedHealthcare Commercial	$15.55

PANT SCRUB REV MISTY ENCORE

Facility

$31.10

Hospital Charge Code	270658873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.67

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658874
Hospital Revenue Code	270
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

PANT SCRUB REV MISTY ENCORE

Facility

$24.15

Hospital Charge Code	270658874
Hospital Revenue Code	270
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.07
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: Aetna Medicare Advantage	$7.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.16
Rate for Payer: Cigna Commercial	$12.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.07

PANT SCRUB REV MISTY ENCORE

Facility

$25.10

Hospital Charge Code	270658872
Hospital Revenue Code	270
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$3.77

PAP

Facility

$142.55

Service Code	HCPCS 88141
Hospital Charge Code	3005304
Hospital Revenue Code	311
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

PAP

Facility

$142.55

Service Code	HCPCS 88141
Hospital Charge Code	3005304
Hospital Revenue Code	311
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.77
Rate for Payer: Aetna Medicare Advantage	$42.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.35
Rate for Payer: Cigna Commercial	$27.06
Rate for Payer: Cigna Medicare Advantage	$13.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$114.00

PAPAIN CHLOROPHYLLIN UREA

Facility

$185.00

Hospital Charge Code	6011043
Hospital Revenue Code	251
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

PAPAIN CHLOROPHYLLIN UREA

Facility

$185.00

Hospital Charge Code	6011043
Hospital Revenue Code	251
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

PAPAIN CHLOROPHYLLIN UREA OINT

Facility

$314.90

Hospital Charge Code	60628434
Hospital Revenue Code	250
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$157.45
Rate for Payer: Aetna Commercial	$94.47
Rate for Payer: Aetna Medicare Advantage	$94.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.30
Rate for Payer: Cigna Commercial	$157.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.94
Rate for Payer: Oxford Commercial	$157.45
Rate for Payer: Qualcare PPO/HMO/WC	$47.23
Rate for Payer: UnitedHealthcare Commercial	$157.45

PAPAIN CHLOROPHYLLIN UREA OINT

Facility

$314.90

Hospital Charge Code	60628434
Hospital Revenue Code	250
Min. Negotiated Rate	$47.23
Max. Negotiated Rate	$47.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.23

PAPAIN-UREA TOPICAL OINT

Facility

$419.25

Hospital Charge Code	60628883
Hospital Revenue Code	250
Min. Negotiated Rate	$62.89
Max. Negotiated Rate	$62.89
Rate for Payer: Qualcare PPO/HMO/WC	$62.89

PAPAIN-UREA TOPICAL OINT

Facility

$419.25

Hospital Charge Code	60628883
Hospital Revenue Code	250
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$209.62
Rate for Payer: Aetna Commercial	$125.78
Rate for Payer: Aetna Medicare Advantage	$125.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.91
Rate for Payer: Cigna Commercial	$209.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.50
Rate for Payer: Oxford Commercial	$209.62
Rate for Payer: Qualcare PPO/HMO/WC	$62.89
Rate for Payer: UnitedHealthcare Commercial	$209.62

PAPARELA TY 1.02 VNT TB 510041

Facility

$66.00

Hospital Charge Code	270639205
Hospital Revenue Code	272
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

PAPARELA TY 1.02 VNT TB 510041

Facility

$66.00

Hospital Charge Code	270639205
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

PAPARELA TY 1.14 VT TBE 510061

Facility

$66.00

Hospital Charge Code	270639206
Hospital Revenue Code	272
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

PAPARELA TY 1.14 VT TBE 510061

Facility

$66.00

Hospital Charge Code	270639206
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

PAPAVERINE 150 MG ER CAP

Facility

$2.45

Hospital Charge Code	60627661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

PAPAVERINE 150 MG ER CAP

Facility

$2.45

Hospital Charge Code	60627661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

PAPAVERINE 300MG/10ML INJ

Facility

$1,438.16

Service Code	HCPCS J2440
Hospital Charge Code	60627662
Hospital Revenue Code	636
Min. Negotiated Rate	$215.72
Max. Negotiated Rate	$348.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.03
Rate for Payer: Qualcare PPO/HMO/WC	$215.72

PAPAVERINE 300MG/10ML INJ

Facility

$1,438.16

Service Code	HCPCS J2440
Hospital Charge Code	60627662
Hospital Revenue Code	636
Min. Negotiated Rate	$215.72
Max. Negotiated Rate	$719.08
Rate for Payer: Aetna Commercial	$431.45
Rate for Payer: Aetna Medicare Advantage	$431.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.73
Rate for Payer: Cigna Commercial	$719.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.03
Rate for Payer: Qualcare PPO/HMO/WC	$215.72

Know your out-of-pocket cost for care.

All Charges