Heights University Hospital

All Charges

Charge

Type

Setting

Price

PENICILLIN G PROC IM 0.6MU/1ML

Facility

$19.85

Hospital Charge Code	60627308
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PENICILLIN G PROC IM 0.6MU/1ML

Facility

$19.85

Hospital Charge Code	60627308
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

PENICILLIN G PROC IM 1.2MU/2ML

Facility

$19.25

Hospital Charge Code	60627309
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

PENICILLIN G PROC IM 1.2MU/2ML

Facility

$19.25

Hospital Charge Code	60627309
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$11.71
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.97
Rate for Payer: Cigna Commercial	$11.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.04
Rate for Payer: Oxford Commercial	$11.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.51
Rate for Payer: UnitedHealthcare Commercial	$11.71

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.51

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$37.38
Rate for Payer: Aetna Commercial	$22.43
Rate for Payer: Aetna Medicare Advantage	$22.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.07
Rate for Payer: Cigna Commercial	$37.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.72
Rate for Payer: Oxford Commercial	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$11.22
Rate for Payer: UnitedHealthcare Commercial	$37.38

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$11.22

PENICILLIN VK TAB 250MG

Facility

$1.95

Hospital Charge Code	6022719
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

PENICILLIN VK TAB 250MG

Facility

$1.95

Hospital Charge Code	6022719
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.42

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$14.74
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare Advantage	$8.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.52
Rate for Payer: Cigna Commercial	$14.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.83
Rate for Payer: Oxford Commercial	$14.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.42
Rate for Payer: UnitedHealthcare Commercial	$14.74

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$2.31

PENICILLIN V POTAS TAB 500MG

Facility

$4.00

Hospital Charge Code	60627313
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PENICILLIN V POTAS TAB 500MG

Facility

$4.00

Hospital Charge Code	60627313
Hospital Revenue Code	251
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

PENICIL PHEN SUSP 250MG/5ML

Facility

$21.15

Hospital Charge Code	6004139
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

PENICIL PHEN SUSP 250MG/5ML

Facility

$21.15

Hospital Charge Code	6004139
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$16,849.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$20,887.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$2,150.00
Rate for Payer: Aetna Commercial	$1,290.00
Rate for Payer: Aetna Medicare Advantage	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,096.50
Rate for Payer: Cigna Commercial	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.00
Rate for Payer: Oxford Commercial	$2,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00
Rate for Payer: UnitedHealthcare Commercial	$2,150.00

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$645.00
Max. Negotiated Rate	$645.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.27
Max. Negotiated Rate	$7,042.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.27
Max. Negotiated Rate	$14,550.90
Rate for Payer: Aetna Commercial	$8,730.54
Rate for Payer: Aetna Medicare Advantage	$8,730.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,420.96
Rate for Payer: Cigna Commercial	$14,550.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$244.27
Max. Negotiated Rate	$244.27
Rate for Payer: Qualcare PPO/HMO/WC	$244.27

Know your out-of-pocket cost for care.

All Charges