Heights University Hospital

All Charges

Charge

Type

Setting

Price

PENICILLIN G 5MU VIAL

Facility

$106.40

Service Code	HCPCS J2540
Hospital Charge Code	60627305
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$31.92
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$31.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.13
Rate for Payer: Cigna Commercial	$0.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.96

PENICILLIN G BENZATHINE 1.2MU

Facility

$700.82

Service Code	HCPCS J0561
Hospital Charge Code	6008973
Hospital Revenue Code	636
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$210.25
Rate for Payer: Aetna Commercial	$210.25
Rate for Payer: Aetna Medicare Advantage	$210.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.12

PENICILLIN G BENZATHINE 1.2MU

Facility

$86.40

Hospital Charge Code	6006928
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$43.20

PENICILLIN G BENZATHINE 1.2MU

Facility

$64.00

Hospital Charge Code	6006423
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

PENICILLIN G BENZATHINE 1.2MU

Facility

$64.00

Hospital Charge Code	6006423
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PENICILLIN G BENZATHINE 1.2MU

Facility

$700.82

Service Code	HCPCS J0561
Hospital Charge Code	6008973
Hospital Revenue Code	636
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$169.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.12

PENICILLIN G BENZATHINE 1.2MU

Facility

$86.40

Hospital Charge Code	6006928
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

PENICILLIN G BENZATHINE 2.4MU

Facility

$203.55

Hospital Charge Code	6008981
Hospital Revenue Code	250
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$61.06
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.46
Rate for Payer: Oxford Commercial	$101.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$101.78

PENICILLIN G BENZATHINE 2.4MU

Facility

$203.55

Hospital Charge Code	6008981
Hospital Revenue Code	250
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$215.40
Max. Negotiated Rate	$347.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$215.40
Max. Negotiated Rate	$430.80
Rate for Payer: Aetna Commercial	$430.80
Rate for Payer: Aetna Medicare Advantage	$430.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40

PENICILLIN G BENZAT PROC 1.2MU

Facility

$64.00

Hospital Charge Code	6006431
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PENICILLIN G BENZAT PROC 1.2MU

Facility

$64.00

Hospital Charge Code	6006431
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

PENICILLIN G INJ SODIUM 5MU

Facility

$62.10

Hospital Charge Code	6008999
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$31.05

PENICILLIN G INJ SODIUM 5MU

Facility

$62.10

Hospital Charge Code	6008999
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

PENICILLIN G IVPB 5MU/D5W100ML

Facility

$12.80

Hospital Charge Code	60627307
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

PENICILLIN G IVPB 5MU/D5W100ML

Facility

$12.80

Hospital Charge Code	60627307
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

PENICILLIN G IVPB 5MU/NS 100ML

Facility

$25.60

Hospital Charge Code	60627306
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

PENICILLIN G IVPB 5MU/NS 100ML

Facility

$25.60

Hospital Charge Code	60627306
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

PENICILLIN G POTAS INJ 5MU

Facility

$25.60

Hospital Charge Code	6009955
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

PENICILLIN G POTAS INJ 5MU

Facility

$142.75

Hospital Charge Code	6004097
Hospital Revenue Code	250
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

PENICILLIN G POTAS INJ 5MU

Facility

$25.60

Hospital Charge Code	6009955
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

PENICILLIN G POTAS INJ 5MU

Facility

$142.75

Hospital Charge Code	6004097
Hospital Revenue Code	250
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$42.83
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.56
Rate for Payer: Oxford Commercial	$71.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$71.38

PENICILLIN G PRO300,000U/ML10M

Facility

$203.55

Hospital Charge Code	6004105
Hospital Revenue Code	250
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$61.06
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.46
Rate for Payer: Oxford Commercial	$101.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$101.78

PENICILLIN G PRO300,000U/ML10M

Facility

$203.55

Hospital Charge Code	6004105
Hospital Revenue Code	250
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

Know your out-of-pocket cost for care.

All Charges