Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERFOROMIST 20MCG/2ML NEB VIAL

Facility

$190.28

Service Code	NDC 49502060530
Hospital Charge Code	606390223
Hospital Revenue Code	250
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$28.54
Rate for Payer: Qualcare PPO/HMO/WC	$28.54

PERGOLIDE 0.05 MG TAB

Facility

$7.25

Hospital Charge Code	60628680
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

PERGOLIDE 0.05 MG TAB

Facility

$7.25

Hospital Charge Code	60628680
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

PERGOLIDE 0.25 MG TAB

Facility

$10.45

Hospital Charge Code	60628678
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

PERGOLIDE 0.25 MG TAB

Facility

$10.45

Hospital Charge Code	60628678
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PERGOLIDE 1 MG TAB

Facility

$30.45

Hospital Charge Code	60628679
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$9.13
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$15.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$15.22

PERGOLIDE 1 MG TAB

Facility

$30.45

Hospital Charge Code	60628679
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.57

PERGONAL/75U

Facility

$310.00

Hospital Charge Code	60633630
Hospital Revenue Code	250
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

PERGONAL/75U

Facility

$310.00

Hospital Charge Code	60633630
Hospital Revenue Code	250
Min. Negotiated Rate	$40.30
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$93.00
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.30
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$155.00

PERI ACCUCHECK (EACH TIME)

Facility

$56.00

Service Code	HCPCS 82948
Hospital Charge Code	74308200
Hospital Revenue Code	301
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

PERI ACCUCHECK (EACH TIME)

Facility

$56.00

Service Code	HCPCS 82948
Hospital Charge Code	74308200
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.33
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$5.04
Rate for Payer: Cigna Medicare Advantage	$2.52
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.34
Rate for Payer: Wellcare Medicare Advantage	$5.04

PERIACTIN/2MG/5ML

Facility

$114.00

Hospital Charge Code	60633631
Hospital Revenue Code	250
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

PERIACTIN/2MG/5ML

Facility

$114.00

Hospital Charge Code	60633631
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Commercial	$57.00

PERIACTIN/4MG/TAB

Facility

$4.00

Hospital Charge Code	60633632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERIACTIN/4MG/TAB

Facility

$4.00

Hospital Charge Code	60633632
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

PERI AMNIOCENTESIS

Facility

$591.00

Service Code	HCPCS 59000
Hospital Charge Code	74308030
Hospital Revenue Code	514
Min. Negotiated Rate	$88.65
Max. Negotiated Rate	$88.65
Rate for Payer: Qualcare PPO/HMO/WC	$88.65

PERI AMNIOCENTESIS

Facility

$591.00

Service Code	HCPCS 59000
Hospital Charge Code	74308030
Hospital Revenue Code	514
Min. Negotiated Rate	$76.83
Max. Negotiated Rate	$2,193.38
Rate for Payer: Aetna Commercial	$177.30
Rate for Payer: Aetna Medicare Advantage	$177.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.71
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.83
Rate for Payer: Qualcare PPO/HMO/WC	$88.65

PERI AMNIOINFUSION

Facility

$3,138.00

Service Code	HCPCS 59070
Hospital Charge Code	74308015
Hospital Revenue Code	361
Min. Negotiated Rate	$470.70
Max. Negotiated Rate	$470.70
Rate for Payer: Qualcare PPO/HMO/WC	$470.70

PERI AMNIOINFUSION

Facility

$3,138.00

Service Code	HCPCS 59070
Hospital Charge Code	74308015
Hospital Revenue Code	361
Min. Negotiated Rate	$407.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$941.40
Rate for Payer: Aetna Medicare Advantage	$941.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.19
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$470.70
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

PERI AMNIOTIC FLUID REDUCT

Facility

$1,706.00

Service Code	HCPCS 59001
Hospital Charge Code	74308035
Hospital Revenue Code	514
Min. Negotiated Rate	$92.02
Max. Negotiated Rate	$725.69
Rate for Payer: Aetna Commercial	$511.80
Rate for Payer: Aetna Medicare Advantage	$511.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.03
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.78
Rate for Payer: Qualcare PPO/HMO/WC	$255.90

PERI AMNIOTIC FLUID REDUCT

Facility

$1,706.00

Service Code	HCPCS 59001
Hospital Charge Code	74308035
Hospital Revenue Code	514
Min. Negotiated Rate	$255.90
Max. Negotiated Rate	$255.90
Rate for Payer: Qualcare PPO/HMO/WC	$255.90

PERI BALLN ANG AORTIC ADD

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411051
Hospital Revenue Code	361
Min. Negotiated Rate	$1,657.24
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$3,824.40
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG AORTIC ADD

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411051
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG AORTIC INI

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411053
Hospital Revenue Code	361
Min. Negotiated Rate	$1,657.24
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$3,824.40
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG AORTIC INI

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411053
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

Know your out-of-pocket cost for care.

All Charges