Heights University Hospital

All Charges

Charge

Type

Setting

Price

PELVIS W/PO CONTRAST ONLY

Facility

$9,500.00

Service Code	HCPCS 72192
Hospital Charge Code	2200152
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

PEMETREXED 500 MG VIAL

Facility

$24,192.36

Service Code	HCPCS J9305
Hospital Charge Code	60629356
Hospital Revenue Code	636
Min. Negotiated Rate	$3,628.85
Max. Negotiated Rate	$5,854.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,854.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,628.85

PEMETREXED 500 MG VIAL

Facility

$24,192.36

Service Code	HCPCS J9305
Hospital Charge Code	60629356
Hospital Revenue Code	636
Min. Negotiated Rate	$3,628.85
Max. Negotiated Rate	$7,257.71
Rate for Payer: Aetna Commercial	$7,257.71
Rate for Payer: Aetna Medicare Advantage	$7,257.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,169.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,169.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,169.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,854.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,628.85

PEMETREXED DISODIUM 100MG INJ

Facility

$20,424.05

Hospital Charge Code	6063943162
Hospital Revenue Code	636
Min. Negotiated Rate	$3,063.61
Max. Negotiated Rate	$10,212.02
Rate for Payer: Aetna Commercial	$6,127.22
Rate for Payer: Aetna Medicare Advantage	$6,127.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,208.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,208.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,208.13
Rate for Payer: Cigna Commercial	$10,212.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,942.62
Rate for Payer: Qualcare PPO/HMO/WC	$3,063.61

PEMETREXED DISODIUM 100MG INJ

Facility

$20,424.05

Hospital Charge Code	6063943162
Hospital Revenue Code	636
Min. Negotiated Rate	$3,063.61
Max. Negotiated Rate	$4,942.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,942.62
Rate for Payer: Qualcare PPO/HMO/WC	$3,063.61

PEMOLINE 18.75 MG TAB

Facility

$7.25

Hospital Charge Code	60627837
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

PEMOLINE 18.75 MG TAB

Facility

$7.25

Hospital Charge Code	60627837
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

PEN BOVIE SMOKE EVAC 125MM

Facility

$34.15

Hospital Charge Code	270677963
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$17.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$17.07

PEN BOVIE SMOKE EVAC 125MM

Facility

$34.15

Hospital Charge Code	270677963
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PEN BOVIE SMOKE EVAC 165MM

Facility

$34.15

Hospital Charge Code	270677964
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$17.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$17.07

PEN BOVIE SMOKE EVAC 165MM

Facility

$34.15

Hospital Charge Code	270677964
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PEN BOVIE SMOKE EVAC 70MM

Facility

$34.15

Hospital Charge Code	270677962
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$17.07
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna Medicare Advantage	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$17.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$17.07

PEN BOVIE SMOKE EVAC 70MM

Facility

$34.15

Hospital Charge Code	270677962
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165
Hospital Revenue Code	270
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna Medicare Advantage	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.97
Rate for Payer: Cigna Commercial	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.02
Rate for Payer: Oxford Commercial	$7.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.33
Rate for Payer: UnitedHealthcare Commercial	$7.78

PENCIL ELECTROSURGICAL

Facility

$16.05

Hospital Charge Code	270061165N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

PENCIL ELECTROSURGICAL

Facility

$16.07

Hospital Charge Code	27061165
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165
Hospital Revenue Code	270
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

PENCIL ELECTROSURGICAL

Facility

$16.07

Hospital Charge Code	27061165
Hospital Revenue Code	270
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$8.04
Rate for Payer: Aetna Commercial	$4.82
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.10
Rate for Payer: Cigna Commercial	$8.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$8.04

PENCIL ELECTROSURGICAL

Facility

$15.56

Hospital Charge Code	270061165S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna Medicare Advantage	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.97
Rate for Payer: Cigna Commercial	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.02
Rate for Payer: Oxford Commercial	$7.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.33
Rate for Payer: UnitedHealthcare Commercial	$7.78

PENCIL ELECTROSURGICAL

Facility

$16.05

Hospital Charge Code	270061165N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$8.03
Rate for Payer: Aetna Commercial	$4.82
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.09
Rate for Payer: Cigna Commercial	$8.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
Rate for Payer: Oxford Commercial	$8.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$8.03

PENCIL ELECTRO-SURGICAL E2515H

Facility

$21.79

Hospital Charge Code	270100702
Hospital Revenue Code	272
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$6.54
Rate for Payer: Aetna Medicare Advantage	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.56
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.83
Rate for Payer: Oxford Commercial	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$10.89

PENCIL ELECTRO-SURGICAL E2515H

Facility

$21.79

Hospital Charge Code	270100702
Hospital Revenue Code	272
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

PENCILLIN G IVPB 2MU/NS 100ML

Facility

$42.25

Hospital Charge Code	60627310
Hospital Revenue Code	250
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.34

PENCILLIN G IVPB 2MU/NS 100ML

Facility

$42.25

Hospital Charge Code	60627310
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna Commercial	$12.68
Rate for Payer: Aetna Medicare Advantage	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.77
Rate for Payer: Cigna Commercial	$21.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.49
Rate for Payer: Oxford Commercial	$21.12
Rate for Payer: Qualcare PPO/HMO/WC	$6.34
Rate for Payer: UnitedHealthcare Commercial	$21.12

Know your out-of-pocket cost for care.

All Charges