Heights University Hospital

All Charges

Charge

Type

Setting

Price

PENTOBARBITAL 50 MG/ML INJ

Facility

$128.00

Hospital Charge Code	60628771
Hospital Revenue Code	250
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$64.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$64.00

PENTOBARBITAL INJ 50MG/1ML

Facility

$102.40

Hospital Charge Code	60628752
Hospital Revenue Code	250
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$15.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.36

PENTOBARBITAL INJ 50MG/1ML

Facility

$102.40

Hospital Charge Code	60628752
Hospital Revenue Code	250
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna Commercial	$30.72
Rate for Payer: Aetna Medicare Advantage	$30.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.11
Rate for Payer: Cigna Commercial	$51.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.31
Rate for Payer: Oxford Commercial	$51.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.36
Rate for Payer: UnitedHealthcare Commercial	$51.20

PENTOBARBITAL (NEMBUTAL)

Facility

$159.25

Service Code	HCPCS 80345
Hospital Charge Code	3004638
Hospital Revenue Code	301
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$23.89
Rate for Payer: Qualcare PPO/HMO/WC	$23.89

PENTOBARBITAL (NEMBUTAL)

Facility

$159.25

Service Code	HCPCS 80345
Hospital Charge Code	3004638
Hospital Revenue Code	301
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.77
Rate for Payer: Aetna Medicare Advantage	$47.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.61
Rate for Payer: Cigna Commercial	$79.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.89
Rate for Payer: UnitedHealthcare Commercial	$114.00

PENTOBARB SOD INJ 50MG/ML 2ML

Facility

$61.45

Hospital Charge Code	6004154
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

PENTOBARB SOD INJ 50MG/ML 2ML

Facility

$61.45

Hospital Charge Code	6004154
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

PENTOBARB SOD SUPP 120MG

Facility

$19.85

Hospital Charge Code	6004162
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PENTOBARB SOD SUPP 120MG

Facility

$19.85

Hospital Charge Code	6004162
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

PENTOSTATIN 10MG

Facility

$6,524.20

Hospital Charge Code	6007017
Hospital Revenue Code	636
Min. Negotiated Rate	$978.63
Max. Negotiated Rate	$3,262.10
Rate for Payer: Aetna Commercial	$1,957.26
Rate for Payer: Aetna Medicare Advantage	$1,957.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.67
Rate for Payer: Cigna Commercial	$3,262.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.86
Rate for Payer: Qualcare PPO/HMO/WC	$978.63

PENTOSTATIN 10MG

Facility

$6,524.20

Hospital Charge Code	6007017
Hospital Revenue Code	636
Min. Negotiated Rate	$978.63
Max. Negotiated Rate	$1,578.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.86
Rate for Payer: Qualcare PPO/HMO/WC	$978.63

PENTOTHAL 500MG VIAL

Facility

$92.00

Hospital Charge Code	60635633
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PENTOTHAL 500MG VIAL

Facility

$92.00

Hospital Charge Code	60635633
Hospital Revenue Code	250
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$46.00

PENTOTHAL INJ/1GM

Facility

$63.00

Hospital Charge Code	60634945
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

PENTOTHAL INJ/1GM

Facility

$63.00

Hospital Charge Code	60634945
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.19
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$31.50

PENTOTHAL SODIUM 400MG/20 ML

Facility

$34.60

Hospital Charge Code	6007710
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

PENTOTHAL SODIUM 400MG/20 ML

Facility

$34.60

Hospital Charge Code	6007710
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

PENTOXIFYLLINE 400 MG ER TAB

Facility

$10.05

Service Code	NDC 51079088920
Hospital Charge Code	60627537
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

PENTOXIFYLLINE 400 MG ER TAB

Facility

$10.05

Service Code	NDC 51079088920
Hospital Charge Code	60627537
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$5.03

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131N
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131N
Hospital Revenue Code	272
Min. Negotiated Rate	$237.25
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.25
Rate for Payer: Oxford Commercial	$912.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$912.50

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131
Hospital Revenue Code	272
Min. Negotiated Rate	$237.25
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.25
Rate for Payer: Oxford Commercial	$912.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$912.50

PEN VEC K/500MG/UD

Facility

$6.97

Service Code	NDC 54868117301
Hospital Charge Code	60634672
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PEN VEC K/500MG/UD

Facility

$6.97

Service Code	NDC 54868117301
Hospital Charge Code	60634672
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.48
Rate for Payer: Aetna Commercial	$2.09
Rate for Payer: Aetna Medicare Advantage	$2.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.48

Know your out-of-pocket cost for care.

All Charges