Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRED FORTE 1% OPHTH/5ML

Facility

$65.00

Hospital Charge Code	60633696
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

PRED FORTE 1% OPHTH/5ML

Facility

$65.00

Hospital Charge Code	60633696
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$32.50

PRED MILD 0.12% OPHTH/5ML

Facility

$89.00

Hospital Charge Code	60633698
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

PRED MILD 0.12% OPHTH/5ML

Facility

$89.00

Hospital Charge Code	60633698
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

PREDNISOLONE 1% EYE DROP 15ML

Facility

$365.48

Hospital Charge Code	606350920
Hospital Revenue Code	250
Min. Negotiated Rate	$54.82
Max. Negotiated Rate	$54.82
Rate for Payer: Qualcare PPO/HMO/WC	$54.82

PREDNISOLONE 1% EYE DROP 15ML

Facility

$365.48

Hospital Charge Code	606350920
Hospital Revenue Code	250
Min. Negotiated Rate	$47.51
Max. Negotiated Rate	$182.74
Rate for Payer: Aetna Commercial	$109.64
Rate for Payer: Aetna Medicare Advantage	$109.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.20
Rate for Payer: Cigna Commercial	$182.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.51
Rate for Payer: Oxford Commercial	$182.74
Rate for Payer: Qualcare PPO/HMO/WC	$54.82
Rate for Payer: UnitedHealthcare Commercial	$182.74

PREDNISOLONE 5MG/5ML

Facility

$70.40

Hospital Charge Code	6017081
Hospital Revenue Code	251
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

PREDNISOLONE 5MG/5ML

Facility

$70.40

Hospital Charge Code	6017081
Hospital Revenue Code	251
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

PREDNISOLONE 5MG/5ML SYR 120ML

Facility

$96.00

Hospital Charge Code	60628782
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PREDNISOLONE 5MG/5ML SYR 120ML

Facility

$96.00

Hospital Charge Code	60628782
Hospital Revenue Code	250
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$48.00

PREDNISOLONE 5MG/5ML SYRUP

Facility

$131.25

Hospital Charge Code	60629118
Hospital Revenue Code	636
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$39.38
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.76
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

PREDNISOLONE 5MG/5ML SYRUP

Facility

$131.25

Hospital Charge Code	60629118
Hospital Revenue Code	636
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$31.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.76
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

PREDNISOLONE ACETATE 1% EYE

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	60628041
Hospital Revenue Code	250
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$55.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.60

PREDNISOLONE ACETATE 1% EYE

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	60628041
Hospital Revenue Code	250
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$185.32
Rate for Payer: Aetna Commercial	$111.19
Rate for Payer: Aetna Medicare Advantage	$111.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.51
Rate for Payer: Cigna Commercial	$185.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.18
Rate for Payer: Oxford Commercial	$185.32
Rate for Payer: Qualcare PPO/HMO/WC	$55.60
Rate for Payer: UnitedHealthcare Commercial	$185.32

PREDNISOLONE ACETATE 1% OPHTH

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	6063943239
Hospital Revenue Code	250
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$185.32
Rate for Payer: Aetna Commercial	$111.19
Rate for Payer: Aetna Medicare Advantage	$111.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.51
Rate for Payer: Cigna Commercial	$185.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.18
Rate for Payer: Oxford Commercial	$185.32
Rate for Payer: Qualcare PPO/HMO/WC	$55.60
Rate for Payer: UnitedHealthcare Commercial	$185.32

PREDNISOLONE ACETATE 1% OPHTH

Facility

$370.64

Service Code	NDC 61314063705
Hospital Charge Code	6063943239
Hospital Revenue Code	250
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$55.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.60

PREDNISOLONE ACET OPH 1% 10ML

Facility

$43.55

Hospital Charge Code	6004618
Hospital Revenue Code	251
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

PREDNISOLONE ACET OPH 1% 10ML

Facility

$43.55

Hospital Charge Code	6004618
Hospital Revenue Code	251
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

PREDNISOLONE ACET OPH .12% 5ML

Facility

$109.45

Hospital Charge Code	6004600
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

PREDNISOLONE ACET OPH .12% 5ML

Facility

$109.45

Hospital Charge Code	6004600
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

PREDNISOLONE ACET OPH 1% 5ML

Facility

$10.90

Hospital Charge Code	6004592
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

PREDNISOLONE ACET OPH 1% 5ML

Facility

$10.90

Hospital Charge Code	6004592
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

PREDNISOLONE ACT OPH .12% 10ML

Facility

$147.85

Hospital Charge Code	6004584
Hospital Revenue Code	251
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

PREDNISOLONE ACT OPH .12% 10ML

Facility

$147.85

Hospital Charge Code	6004584
Hospital Revenue Code	251
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$44.35
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.22
Rate for Payer: Oxford Commercial	$73.92
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$73.92

PREDNISOLONE NEO POLY SSP 5ML

Facility

$136.35

Hospital Charge Code	6004626
Hospital Revenue Code	251
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$40.91
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.73
Rate for Payer: Oxford Commercial	$68.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.45
Rate for Payer: UnitedHealthcare Commercial	$68.17

Know your out-of-pocket cost for care.

All Charges