Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHENYTOIN, FREE, (DILANTIN) I

Facility

$118.00

Service Code	HCPCS 80185
Hospital Charge Code	3031366A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.55
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.04
Rate for Payer: Wellcare Medicare Advantage	$13.25

PHENYTOIN, FREE, (DILANTIN) I

Facility

$118.00

Service Code	HCPCS 80185
Hospital Charge Code	3031366A
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

PHENYTOIN, FREE, (DILANTIN) II

Facility

$149.00

Service Code	HCPCS 80186
Hospital Charge Code	3031366B
Hospital Revenue Code	301
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

PHENYTOIN, FREE, (DILANTIN) II

Facility

$149.00

Service Code	HCPCS 80186
Hospital Charge Code	3031366B
Hospital Revenue Code	301
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.58
Rate for Payer: Aetna Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.42
Rate for Payer: Cigna Commercial	$13.76
Rate for Payer: Cigna Medicare Advantage	$6.88
Rate for Payer: Clover Medicare Advantage	$13.07
Rate for Payer: EmblemHealth Commercial	$41.28
Rate for Payer: Humana Medicare Advantage	$14.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.59
Rate for Payer: Wellcare Medicare Advantage	$13.76

PHENYTOIN SSP 100MG/4ML UD

Facility

$57.89

Service Code	NDC 66689003601
Hospital Charge Code	60627741
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

PHENYTOIN SSP 100MG/4ML UD

Facility

$57.89

Service Code	NDC 66689003601
Hospital Charge Code	60627741
Hospital Revenue Code	250
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$17.37
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.53
Rate for Payer: Oxford Commercial	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$28.95

PHENYTOIN VIAL 100MG

Facility

$3.20

Hospital Charge Code	6022743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

PHENYTOIN VIAL 100MG

Facility

$3.20

Hospital Charge Code	6022743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

PHENYTOIN VIAL 250MG

Facility

$3.85

Hospital Charge Code	6013130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

PHENYTOIN VIAL 250MG

Facility

$3.85

Hospital Charge Code	6013130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	366883986
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	366883986
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39708031
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH FECES

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39708031
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH, FLUID

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38473058
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH, FLUID

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38473058
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PHILADELPHIA CHROMOSOME

Facility

$2,902.00

Service Code	HCPCS 88262
Hospital Charge Code	38474103
Hospital Revenue Code	311
Min. Negotiated Rate	$435.30
Max. Negotiated Rate	$435.30
Rate for Payer: Qualcare PPO/HMO/WC	$435.30

PHILADELPHIA CHROMOSOME

Facility

$2,902.00

Service Code	HCPCS 88262
Hospital Charge Code	38474103
Hospital Revenue Code	311
Min. Negotiated Rate	$62.74
Max. Negotiated Rate	$459.80
Rate for Payer: Aetna Commercial	$406.59
Rate for Payer: Aetna Medicare Advantage	$125.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$125.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.80
Rate for Payer: Cigna Commercial	$125.49
Rate for Payer: Cigna Medicare Advantage	$62.74
Rate for Payer: Clover Medicare Advantage	$119.22
Rate for Payer: EmblemHealth Commercial	$376.47
Rate for Payer: Humana Medicare Advantage	$129.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$125.49
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$133.02
Rate for Payer: Wellcare Medicare Advantage	$125.49

PHISODERM/150ML

Facility

$18.00

Hospital Charge Code	60633658
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PHISODERM/150ML

Facility

$18.00

Hospital Charge Code	60633658
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

PHISODERM FOR BABY/150ML

Facility

$18.00

Hospital Charge Code	60633659
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

PHISODERM FOR BABY/150ML

Facility

$18.00

Hospital Charge Code	60633659
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PHLEB VEINS - EXTREM 20+

Facility

$17,623.95

Service Code	HCPCS 37766
Hospital Charge Code	421037766
Hospital Revenue Code	761
Min. Negotiated Rate	$487.60
Max. Negotiated Rate	$8,811.98
Rate for Payer: Aetna Commercial	$5,287.19
Rate for Payer: Aetna Medicare Advantage	$5,287.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$487.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,494.11
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,291.11
Rate for Payer: Oxford Commercial	$8,811.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$8,811.98

PHLEB VEINS - EXTREM 20+

Facility

$17,623.95

Service Code	HCPCS 37766
Hospital Charge Code	421037766
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

PHOSLO GEL CAPS

Facility

$1.00

Hospital Charge Code	60635476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

Know your out-of-pocket cost for care.

All Charges