Heights University Hospital

All Charges

Charge

Type

Setting

Price

PILOCARPINE OPHT .5% 15ML

Facility

$9.65

Hospital Charge Code	6004345
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 .5% 15ML

Facility

$9.65

Hospital Charge Code	6004345
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 6% 15ML

Facility

$10.45

Hospital Charge Code	6004402
Hospital Revenue Code	251
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PILOCARPINE OPHT 6% 15ML

Facility

$10.45

Hospital Charge Code	6004402
Hospital Revenue Code	251
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

PILOCARPINE OPHT 8% 15ML

Facility

$185.00

Hospital Charge Code	6004410
Hospital Revenue Code	251
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

PILOCARPINE OPHT 8% 15ML

Facility

$185.00

Hospital Charge Code	6004410
Hospital Revenue Code	251
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

PILOCARPINE SOL OPH 10%

Facility

$218.45

Hospital Charge Code	60628062
Hospital Revenue Code	250
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

PILOCARPINE SOL OPH 10%

Facility

$218.45

Hospital Charge Code	60628062
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 SOL OPH 10% 15ML

Facility

$192.65

Hospital Charge Code	6004428
Hospital Revenue Code	251
Min. Negotiated Rate	$25.04
Max. Negotiated Rate	$96.33
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare Advantage	$57.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.13
Rate for Payer: Cigna Commercial	$96.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.04
Rate for Payer: Oxford Commercial	$96.33
Rate for Payer: Qualcare PPO/HMO/WC	$28.90
Rate for Payer: UnitedHealthcare Commercial	$96.33

PILOCARPINE SOL OPH 10% 15ML

Facility

$192.65

Hospital Charge Code	6004428
Hospital Revenue Code	251
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$28.90
Rate for Payer: Qualcare PPO/HMO/WC	$28.90

PILOCARPINE SOL OPH 2% 1ML

Facility

$14.75

Hospital Charge Code	60628061
Hospital Revenue Code	259
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

PILOCARPINE SOL OPH 2% 1ML

Facility

$14.75

Hospital Charge Code	60628061
Hospital Revenue Code	259
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$7.38

PILOCARPINE SOL OPH 4% 1ML

Facility

$24.85

Hospital Charge Code	60628063
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

PILOCARPINE SOL OPH 4% 1ML

Facility

$24.85

Hospital Charge Code	60628063
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$7.46
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$12.43

PILOT DRILL SHORT 2.0MM QUICK

Facility

$768.75

Hospital Charge Code	270669683
Hospital Revenue Code	272
Min. Negotiated Rate	$115.31
Max. Negotiated Rate	$115.31
Rate for Payer: Qualcare PPO/HMO/WC	$115.31

PILOT DRILL SHORT 2.0MM QUICK

Facility

$768.75

Hospital Charge Code	270669683
Hospital Revenue Code	272
Min. Negotiated Rate	$99.94
Max. Negotiated Rate	$384.38
Rate for Payer: Aetna Commercial	$230.62
Rate for Payer: Aetna Medicare Advantage	$230.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.03
Rate for Payer: Cigna Commercial	$384.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.94
Rate for Payer: Oxford Commercial	$384.38
Rate for Payer: Qualcare PPO/HMO/WC	$115.31
Rate for Payer: UnitedHealthcare Commercial	$384.38

PIMECROLIMUS 1 % CRE

Facility

$124.00

Hospital Charge Code	60629254
Hospital Revenue Code	250
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

PIMECROLIMUS 1 % CRE

Facility

$124.00

Hospital Charge Code	60629254
Hospital Revenue Code	250
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$62.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$62.00

PIMOZIDE 2 MG TAB

Facility

$8.60

Hospital Charge Code	60628684
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.30
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Aetna Medicare Advantage	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$4.30

PIMOZIDE 2 MG TAB

Facility

$8.60

Hospital Charge Code	60628684
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

Facility

$900.00

Hospital Charge Code	270656337
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

Facility

$900.00

Hospital Charge Code	270656337
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

PIN .093(D) X 9L 35361278

Facility

$210.00

Hospital Charge Code	270638404
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

PIN .093(D) X 9L 35361278

Facility

$210.00

Hospital Charge Code	270638404
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$50.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

PIN 12 THR 1.65 MM X 45 MM

Facility

$661.00

Service Code	HCPCS C1713
Hospital Charge Code	270688789
Hospital Revenue Code	278
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$330.50
Rate for Payer: Aetna Commercial	$198.30
Rate for Payer: Aetna Medicare Advantage	$198.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.56
Rate for Payer: Cigna Commercial	$330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.15

Know your out-of-pocket cost for care.

All Charges