Heights University Hospital

All Charges

Charge

Type

Setting

Price

PREGABALIN

Facility

$72.40

Service Code	HCPCS 80299
Hospital Charge Code	39708027
Hospital Revenue Code	301
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$10.86
Rate for Payer: Qualcare PPO/HMO/WC	$10.86

PREGABALIN 100 MG CAP

Facility

$38.59

Service Code	NDC 71101568
Hospital Charge Code	60629900
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$11.58
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$19.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$19.30

PREGABALIN 100 MG CAP

Facility

$38.59

Service Code	NDC 71101568
Hospital Charge Code	60629900
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 25 MG CAP

Facility

$38.59

Service Code	NDC 71101268
Hospital Charge Code	60629877
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 25 MG CAP

Facility

$38.59

Service Code	NDC 71101268
Hospital Charge Code	60629877
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$11.58
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$19.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$19.30

PREGABALIN 50 MG CAP

Facility

$38.59

Service Code	NDC 71101368
Hospital Charge Code	60629899
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 50 MG CAP

Facility

$38.59

Service Code	NDC 71101368
Hospital Charge Code	60629899
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$11.58
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$19.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$19.30

PREGABALIN 75 MG CAP

Facility

$38.59

Service Code	NDC 71101468
Hospital Charge Code	60629881
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$11.58
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$19.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$19.30

PREGABALIN 75 MG CAP

Facility

$38.59

Service Code	NDC 71101468
Hospital Charge Code	60629881
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN SERUM

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3035118
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

PREGABALIN SERUM

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3035118
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

PREGNA>1ST TRIM EA ADD

Facility

$1,393.00

Service Code	HCPCS 76810
Hospital Charge Code	94061171
Hospital Revenue Code	402
Min. Negotiated Rate	$99.38
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$417.90
Rate for Payer: Aetna Medicare Advantage	$417.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.21
Rate for Payer: Cigna Commercial	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.09
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.95
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PREGNA>1ST TRIM EA ADD

Facility

$1,393.00

Service Code	HCPCS 76810
Hospital Charge Code	94061171
Hospital Revenue Code	402
Min. Negotiated Rate	$208.95
Max. Negotiated Rate	$208.95
Rate for Payer: Qualcare PPO/HMO/WC	$208.95

PREGNANCY>1ST TRIM SGL

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	94061169
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PREGNANCY>1ST TRIM SGL

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	94061169
Hospital Revenue Code	402
Min. Negotiated Rate	$120.80
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PREGNANCY TEST***

Facility

$25.00

Hospital Charge Code	3012168
Hospital Revenue Code	309
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

PREGNANCY TEST***

Facility

$25.00

Hospital Charge Code	3012168
Hospital Revenue Code	309
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PREGNANCY, URINE QUAL

Facility

$123.44

Service Code	HCPCS 84703
Hospital Charge Code	3002169
Hospital Revenue Code	301
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$24.36
Rate for Payer: Aetna Medicare Advantage	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.55
Rate for Payer: Cigna Commercial	$7.52
Rate for Payer: Cigna Medicare Advantage	$3.76
Rate for Payer: Clover Medicare Advantage	$7.14
Rate for Payer: EmblemHealth Commercial	$22.56
Rate for Payer: Humana Medicare Advantage	$7.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.97
Rate for Payer: Wellcare Medicare Advantage	$7.52

PREGNANCY, URINE QUAL

Facility

$123.44

Service Code	HCPCS 84703
Hospital Charge Code	3002169
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

PREGNANCY,URINE-QUAL/VISUAL

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	38477014
Hospital Revenue Code	307
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.90
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: Cigna Medicare Advantage	$4.30
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.13
Rate for Payer: Wellcare Medicare Advantage	$8.61

PREGNANCY,URINE-QUAL/VISUAL

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	38477014
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

PREGNANDIOL***

Facility

$60.00

Hospital Charge Code	3012176
Hospital Revenue Code	309
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

PREGNANDIOL***

Facility

$60.00

Hospital Charge Code	3012176
Hospital Revenue Code	309
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

PREGN-ASSC PLASMA PROTEIN-A

Facility

$106.64

Service Code	HCPCS 84163
Hospital Charge Code	38477128
Hospital Revenue Code	301
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

PREGN-ASSC PLASMA PROTEIN-A

Facility

$106.64

Service Code	HCPCS 84163
Hospital Charge Code	38477128
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.00

Know your out-of-pocket cost for care.

All Charges