Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRAMOXINE 1% AEROSOL

Facility

$158.10

Hospital Charge Code	60628422
Hospital Revenue Code	250
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$79.05
Rate for Payer: Aetna Commercial	$47.43
Rate for Payer: Aetna Medicare Advantage	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.32
Rate for Payer: Cigna Commercial	$79.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.55
Rate for Payer: Oxford Commercial	$79.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.71
Rate for Payer: UnitedHealthcare Commercial	$79.05

PRAMOXINE 1% AEROSOL

Facility

$158.10

Hospital Charge Code	60628422
Hospital Revenue Code	250
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$23.71
Rate for Payer: Qualcare PPO/HMO/WC	$23.71

PRAMOXINE FOAM 15GM

Facility

$109.45

Hospital Charge Code	6007389
Hospital Revenue Code	251
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.23
Rate for Payer: Oxford Commercial	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$54.73

PRAMOXINE FOAM 15GM

Facility

$109.45

Hospital Charge Code	6007389
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

PRAMOXINE HCL CRM 1%

Facility

$211.25

Hospital Charge Code	60628402
Hospital Revenue Code	250
Min. Negotiated Rate	$27.46
Max. Negotiated Rate	$105.62
Rate for Payer: Aetna Commercial	$63.38
Rate for Payer: Aetna Medicare Advantage	$63.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.87
Rate for Payer: Cigna Commercial	$105.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.46
Rate for Payer: Oxford Commercial	$105.62
Rate for Payer: Qualcare PPO/HMO/WC	$31.69
Rate for Payer: UnitedHealthcare Commercial	$105.62

PRAMOXINE HCL CRM 1%

Facility

$211.25

Hospital Charge Code	60628402
Hospital Revenue Code	250
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$31.69

PRAMOXINE HCL OIN1% ZN OX12.5%

Facility

$38.45

Hospital Charge Code	60628423
Hospital Revenue Code	250
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

PRAMOXINE HCL OIN1% ZN OX12.5%

Facility

$38.45

Hospital Charge Code	60628423
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$19.23
Rate for Payer: Aetna Commercial	$11.54
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.80
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.00
Rate for Payer: Oxford Commercial	$19.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$19.23

PRAMOXINE SOL 1%

Facility

$652.45

Service Code	NDC 37682315
Hospital Charge Code	60628421
Hospital Revenue Code	250
Min. Negotiated Rate	$97.87
Max. Negotiated Rate	$97.87
Rate for Payer: Qualcare PPO/HMO/WC	$97.87

PRAMOXINE SOL 1%

Facility

$652.45

Service Code	NDC 37682315
Hospital Charge Code	60628421
Hospital Revenue Code	250
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$326.23
Rate for Payer: Aetna Commercial	$195.74
Rate for Payer: Aetna Medicare Advantage	$195.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.37
Rate for Payer: Cigna Commercial	$326.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.82
Rate for Payer: Oxford Commercial	$326.23
Rate for Payer: Qualcare PPO/HMO/WC	$97.87
Rate for Payer: UnitedHealthcare Commercial	$326.23

PRANDIN 1 MG

Facility

$60.43

Service Code	NDC 60846088201
Hospital Charge Code	60632257
Hospital Revenue Code	250
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$30.21
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare Advantage	$18.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$30.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.86
Rate for Payer: Oxford Commercial	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.06
Rate for Payer: UnitedHealthcare Commercial	$30.21

PRANDIN 1 MG

Facility

$60.43

Service Code	NDC 60846088201
Hospital Charge Code	60632257
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.06

PRANDIN, 2MG

Facility

$2.00

Hospital Charge Code	60635445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PRANDIN, 2MG

Facility

$2.00

Hospital Charge Code	60635445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

PRASUGREL 10MG TAB

Facility

$86.63

Service Code	NDC 2512377
Hospital Charge Code	60630033
Hospital Revenue Code	250
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$12.99
Rate for Payer: Qualcare PPO/HMO/WC	$12.99

PRASUGREL 10MG TAB

Facility

$86.63

Service Code	NDC 2512377
Hospital Charge Code	60630033
Hospital Revenue Code	250
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$43.31
Rate for Payer: Aetna Commercial	$25.99
Rate for Payer: Aetna Medicare Advantage	$25.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.09
Rate for Payer: Cigna Commercial	$43.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.26
Rate for Payer: Oxford Commercial	$43.31
Rate for Payer: Qualcare PPO/HMO/WC	$12.99
Rate for Payer: UnitedHealthcare Commercial	$43.31

PRAVACHOL 10MG TAB BULK

Facility

$13.00

Hospital Charge Code	60635195
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PRAVACHOL 10MG TAB BULK

Facility

$13.00

Hospital Charge Code	60635195
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

PRAVACHOL 10MG TAB U/D

Facility

$8.00

Hospital Charge Code	60635194
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

PRAVACHOL 10MG TAB U/D

Facility

$8.00

Hospital Charge Code	60635194
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

PRAVACHOL/20MG/TAB

Facility

$13.00

Hospital Charge Code	60634909
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

PRAVACHOL/20MG/TAB

Facility

$13.00

Hospital Charge Code	60634909
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

PRAVACHOL 20MG TAB BULK

Facility

$9.00

Hospital Charge Code	60635196
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PRAVACHOL 20MG TAB BULK

Facility

$9.00

Hospital Charge Code	60635196
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PRAVACHOL 20MG TAB U/D

Facility

$15.00

Hospital Charge Code	60635197
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

Know your out-of-pocket cost for care.

All Charges