Heights University Hospital

All Charges

Charge

Type

Setting

Price

PILLOW SHOULDER ABDUCTN MED

Facility

$156.95

Hospital Charge Code	270652246
Hospital Revenue Code	272
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$23.54
Rate for Payer: Qualcare PPO/HMO/WC	$23.54

PILOCAR 1% OPHTH/1ML

Facility

$13.00

Hospital Charge Code	60633664
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

PILOCAR 1% OPHTH/1ML

Facility

$13.00

Hospital Charge Code	60633664
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PILOCAR 6% EPI 1% OPTH

Facility

$23.00

Hospital Charge Code	60635275
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PILOCAR 6% EPI 1% OPTH

Facility

$23.00

Hospital Charge Code	60635275
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

PILOCAR DROPPERETTES 2% O

Facility

$15.00

Hospital Charge Code	60633663
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

PILOCAR DROPPERETTES 2% O

Facility

$15.00

Hospital Charge Code	60633663
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PILOCARPINE 0.5%

Facility

$28.00

Hospital Charge Code	60634766
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

PILOCARPINE 0.5%

Facility

$28.00

Hospital Charge Code	60634766
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

PILOCARPINE-2 EPINEP-1 SOL OPH

Facility

$195.25

Hospital Charge Code	60628057
Hospital Revenue Code	250
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$29.29
Rate for Payer: Qualcare PPO/HMO/WC	$29.29

PILOCARPINE-2 EPINEP-1 SOL OPH

Facility

$195.25

Hospital Charge Code	60628057
Hospital Revenue Code	250
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$97.62
Rate for Payer: Aetna Commercial	$58.58
Rate for Payer: Aetna Medicare Advantage	$58.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.79
Rate for Payer: Cigna Commercial	$97.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.38
Rate for Payer: Oxford Commercial	$97.62
Rate for Payer: Qualcare PPO/HMO/WC	$29.29
Rate for Payer: UnitedHealthcare Commercial	$97.62

PILOCARPINE-3 EPINEP-1 SOL OPH

Facility

$205.65

Hospital Charge Code	60628058
Hospital Revenue Code	250
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

PILOCARPINE-3 EPINEP-1 SOL OPH

Facility

$205.65

Hospital Charge Code	60628058
Hospital Revenue Code	250
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$102.83
Rate for Payer: Aetna Commercial	$61.70
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$102.83
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$102.83

PILOCARPINE-4 EPINEP-1 SOL OPH

Facility

$218.45

Hospital Charge Code	60628059
Hospital Revenue Code	250
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

PILOCARPINE-4 EPINEP-1 SOL OPH

Facility

$218.45

Hospital Charge Code	60628059
Hospital Revenue Code	250
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$109.22
Rate for Payer: Aetna Commercial	$65.53
Rate for Payer: Aetna Medicare Advantage	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.70
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.40
Rate for Payer: Oxford Commercial	$109.22
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$109.22

PILOCARPINE OPHT 1% 15ML

Facility

$660.35

Service Code	NDC 61314020315
Hospital Charge Code	6004352
Hospital Revenue Code	251
Min. Negotiated Rate	$99.05
Max. Negotiated Rate	$99.05
Rate for Payer: Qualcare PPO/HMO/WC	$99.05

PILOCARPINE OPHT 1% 15ML

Facility

$660.35

Service Code	NDC 61314020315
Hospital Charge Code	6004352
Hospital Revenue Code	251
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$330.18
Rate for Payer: Aetna Commercial	$198.10
Rate for Payer: Aetna Medicare Advantage	$198.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.39
Rate for Payer: Cigna Commercial	$330.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.85
Rate for Payer: Oxford Commercial	$330.18
Rate for Payer: Qualcare PPO/HMO/WC	$99.05
Rate for Payer: UnitedHealthcare Commercial	$330.18

PILOCARPINE OPHT 2% 15ML

Facility

$675.43

Service Code	NDC 998020415
Hospital Charge Code	6004360
Hospital Revenue Code	251
Min. Negotiated Rate	$87.81
Max. Negotiated Rate	$337.71
Rate for Payer: Aetna Commercial	$202.63
Rate for Payer: Aetna Medicare Advantage	$202.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.23
Rate for Payer: Cigna Commercial	$337.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.81
Rate for Payer: Oxford Commercial	$337.71
Rate for Payer: Qualcare PPO/HMO/WC	$101.31
Rate for Payer: UnitedHealthcare Commercial	$337.71

PILOCARPINE OPHT 2% 15ML

Facility

$675.43

Service Code	NDC 998020415
Hospital Charge Code	6004360
Hospital Revenue Code	251
Min. Negotiated Rate	$101.31
Max. Negotiated Rate	$101.31
Rate for Payer: Qualcare PPO/HMO/WC	$101.31

PILOCARPINE OPHT 2ML PRES-FREE

Facility

$53.80

Hospital Charge Code	6004378
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

PILOCARPINE OPHT 2ML PRES-FREE

Facility

$53.80

Hospital Charge Code	6004378
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

PILOCARPINE OPHT 3% 15ML

Facility

$9.65

Hospital Charge Code	6004386
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

PILOCARPINE OPHT 3% 15ML

Facility

$9.65

Hospital Charge Code	6004386
Hospital Revenue Code	251
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PILOCARPINE OPHT 4% 15ML

Facility

$7.70

Hospital Charge Code	6004394
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

PILOCARPINE OPHT 4% 15ML

Facility

$7.70

Hospital Charge Code	6004394
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

Know your out-of-pocket cost for care.

All Charges