Heights University Hospital

All Charges

Charge

Type

Setting

Price

PAXLOVID TABLETS 300MG 100MG D

Facility

$1,167.81

Service Code	NDC 69532103
Hospital Charge Code	6063943397
Hospital Revenue Code	250
Min. Negotiated Rate	$175.17
Max. Negotiated Rate	$175.17
Rate for Payer: Qualcare PPO/HMO/WC	$175.17

PAXLOVID TABLETS 300MG 100MG D

Facility

$1,167.81

Service Code	NDC 69532103
Hospital Charge Code	6063943397
Hospital Revenue Code	250
Min. Negotiated Rate	$151.82
Max. Negotiated Rate	$583.90
Rate for Payer: Aetna Commercial	$350.34
Rate for Payer: Aetna Medicare Advantage	$350.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$297.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$297.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$297.79
Rate for Payer: Cigna Commercial	$583.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.82
Rate for Payer: Oxford Commercial	$583.90
Rate for Payer: Qualcare PPO/HMO/WC	$175.17
Rate for Payer: UnitedHealthcare Commercial	$583.90

PCB POLYCHLORINATED BIPHENY***

Facility

$103.00

Hospital Charge Code	3032679
Hospital Revenue Code	309
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

PCB POLYCHLORINATED BIPHENY***

Facility

$103.00

Hospital Charge Code	3032679
Hospital Revenue Code	309
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$114.00

PC C5E 10FT A/B 8C

Facility

$25.00

Hospital Charge Code	270659103
Hospital Revenue Code	270
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PC C5E 10FT A/B 8C

Facility

$25.00

Hospital Charge Code	270659103
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

PC C5E 3FT BLK A/B 8C

Facility

$11.25

Hospital Charge Code	270659104
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PC C5E 3FT BLK A/B 8C

Facility

$11.25

Hospital Charge Code	270659104
Hospital Revenue Code	270
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

PC C5E 3FT BLUE A/B 8C

Facility

$11.25

Hospital Charge Code	270659101
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PC C5E 3FT BLUE A/B 8C

Facility

$11.25

Hospital Charge Code	270659101
Hospital Revenue Code	270
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

PC C5E 5FT BLUE A/B 8C

Facility

$15.00

Hospital Charge Code	270659102
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

PC C5E 5FT BLUE A/B 8C

Facility

$15.00

Hospital Charge Code	270659102
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PCEEA 25 28 31****

Facility

$875.00

Hospital Charge Code	1600956
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

PCEEA 25 28 31****

Facility

$875.00

Hospital Charge Code	1600956
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.75
Rate for Payer: Oxford Commercial	$437.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$437.50

PCK CSTM GYN LAP AVIBMBM009-08

Facility

$194.95

Hospital Charge Code	270642268
Hospital Revenue Code	272
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$29.24
Rate for Payer: Qualcare PPO/HMO/WC	$29.24

PCK CSTM GYN LAP AVIBMBM009-08

Facility

$194.95

Hospital Charge Code	270642268
Hospital Revenue Code	272
Min. Negotiated Rate	$25.34
Max. Negotiated Rate	$97.47
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.71
Rate for Payer: Cigna Commercial	$97.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.34
Rate for Payer: Oxford Commercial	$97.47
Rate for Payer: Qualcare PPO/HMO/WC	$29.24
Rate for Payer: UnitedHealthcare Commercial	$97.47

PCMKR EXT MEDT BIF DUAL 749851

Facility

$4,014.45

Hospital Charge Code	270611256
Hospital Revenue Code	275
Min. Negotiated Rate	$602.17
Max. Negotiated Rate	$971.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$802.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.50
Rate for Payer: Qualcare PPO/HMO/WC	$602.17

PCMKR EXT MEDT BIF DUAL 749851

Facility

$4,014.45

Hospital Charge Code	270611256
Hospital Revenue Code	275
Min. Negotiated Rate	$602.17
Max. Negotiated Rate	$2,007.22
Rate for Payer: Aetna Commercial	$1,204.34
Rate for Payer: Aetna Medicare Advantage	$1,204.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$802.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.68
Rate for Payer: Cigna Commercial	$2,007.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$971.50
Rate for Payer: Qualcare PPO/HMO/WC	$602.17

PCP, URINE

Facility

$104.99

Service Code	HCPCS 83992
Hospital Charge Code	38472504
Hospital Revenue Code	301
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

PCP, URINE

Facility

$104.99

Service Code	HCPCS 83992
Hospital Charge Code	38472504
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PC RED C5E 10FT

Facility

$25.00

Hospital Charge Code	270659013
Hospital Revenue Code	270
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PC RED C5E 10FT

Facility

$25.00

Hospital Charge Code	270659013
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

PC RED C5E 25 FT

Facility

$50.00

Hospital Charge Code	270659012
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PC RED C5E 25 FT

Facility

$50.00

Hospital Charge Code	270659012
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$25.00

PCR-HIV DNA #H61***

Facility

$431.00

Hospital Charge Code	3010816
Hospital Revenue Code	306
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$64.65

Know your out-of-pocket cost for care.

All Charges