Heights University Hospital

All Charges

Charge

Type

Setting

Price

PEN-VEE K/125MG/5ML

Facility

$13.00

Hospital Charge Code	60633619
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

PEN-VEE K/125MG/5ML

Facility

$13.00

Hospital Charge Code	60633619
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PEN-VEE K/250MG/5ML

Facility

$13.00

Hospital Charge Code	60633620
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PEN-VEE K/250MG/5ML

Facility

$23.00

Hospital Charge Code	60633621
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PEN-VEE K/250MG/5ML

Facility

$13.00

Hospital Charge Code	60633620
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

PEN-VEE K/250MG/5ML

Facility

$23.00

Hospital Charge Code	60633621
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

PEN-VEE K/250MG/TAB

Facility

$4.00

Hospital Charge Code	60633622
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PEN-VEE K/250MG/TAB

Facility

$4.00

Hospital Charge Code	60633622
Hospital Revenue Code	250
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

PEN WLZ CONTOURING 915-3100

Facility

$257.65

Hospital Charge Code	270621792
Hospital Revenue Code	270
Min. Negotiated Rate	$38.65
Max. Negotiated Rate	$38.65
Rate for Payer: Qualcare PPO/HMO/WC	$38.65

PEN WLZ CONTOURING 915-3100

Facility

$257.65

Hospital Charge Code	270621792
Hospital Revenue Code	270
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$128.82
Rate for Payer: Aetna Commercial	$77.30
Rate for Payer: Aetna Medicare Advantage	$77.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$128.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.49
Rate for Payer: Oxford Commercial	$128.82
Rate for Payer: Qualcare PPO/HMO/WC	$38.65
Rate for Payer: UnitedHealthcare Commercial	$128.82

PEPCID/20MG/INJ

Facility

$1.00

Hospital Charge Code	60634898
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PEPCID/20MG/INJ

Facility

$1.00

Hospital Charge Code	60634898
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

PEPCID 20MG PREMIXED

Facility

$48.00

Hospital Charge Code	60635008
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

PEPCID 20MG PREMIXED

Facility

$48.00

Hospital Charge Code	60635008
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

PEPCID/20MG/TAB

Facility

$7.00

Hospital Charge Code	60633624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
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	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

PEPCID/20MG/TAB

Facility

$5.00

Hospital Charge Code	60633625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

PEPCID/20MG/TAB

Facility

$5.00

Hospital Charge Code	60633625
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PEPCID/20MG/TAB

Facility

$7.00

Hospital Charge Code	60633624
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$19.54
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Oxford Commercial	$32.56
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$32.56

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

PEPTAMEN

Facility

$71.00

Hospital Charge Code	60634857
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PEPTAMEN

Facility

$71.00

Hospital Charge Code	60634857
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

PEPTIC ULCER AND GASTRITIS

Facility

$10,326.41

Service Code	APR-DRG 2412
Min. Negotiated Rate	$6,888.69
Max. Negotiated Rate	$10,326.41
Rate for Payer: Aetna Better Health Medicaid	$10,123.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,326.41
Rate for Payer: Wellpoint Medicaid Managed Care	$6,888.69

PEPTIC ULCER AND GASTRITIS

Facility

$15,174.34

Service Code	APR-DRG 2413
Min. Negotiated Rate	$10,352.03
Max. Negotiated Rate	$15,174.34
Rate for Payer: Aetna Better Health Medicaid	$14,876.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,174.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10,352.03

PEPTIC ULCER AND GASTRITIS

Facility

$8,340.60

Service Code	APR-DRG 2411
Min. Negotiated Rate	$5,554.16
Max. Negotiated Rate	$8,340.60
Rate for Payer: Aetna Better Health Medicaid	$8,177.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,340.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5,554.16

Know your out-of-pocket cost for care.

All Charges