Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRGMR PAT STMLTR S/NNKE111075N

Facility

$6,247.50

Hospital Charge Code	270640281
Hospital Revenue Code	278
Min. Negotiated Rate	$937.12
Max. Negotiated Rate	$3,123.75
Rate for Payer: Aetna Commercial	$1,874.25
Rate for Payer: Aetna Medicare Advantage	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.11
Rate for Payer: Cigna Commercial	$3,123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.89
Rate for Payer: Qualcare PPO/HMO/WC	$937.12

PRGMR PAT STMLTR S/NNKE111075N

Facility

$6,247.50

Hospital Charge Code	270640281
Hospital Revenue Code	278
Min. Negotiated Rate	$937.12
Max. Negotiated Rate	$1,511.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.89
Rate for Payer: Qualcare PPO/HMO/WC	$937.12

PRG UTRUS FETL ANAT ABD US SIN

Facility

$2,455.60

Service Code	HCPCS 76811
Hospital Charge Code	83653050
Hospital Revenue Code	402
Min. Negotiated Rate	$368.34
Max. Negotiated Rate	$368.34
Rate for Payer: Qualcare PPO/HMO/WC	$368.34

PRG UTRUS FETL ANAT ABD US SIN

Facility

$2,455.60

Service Code	HCPCS 76811
Hospital Charge Code	83653050
Hospital Revenue Code	402
Min. Negotiated Rate	$319.23
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$736.68
Rate for Payer: Aetna Medicare Advantage	$736.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$381.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.18
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.23
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$368.34
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PRILOSEC 10MG U/D CAP

Facility

$15.00

Hospital Charge Code	60635282
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PRILOSEC 10MG U/D CAP

Facility

$15.00

Hospital Charge Code	60635282
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

PRILOSEC/20MG/CAP

Facility

$15.00

Hospital Charge Code	60633711
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

PRILOSEC/20MG/CAP

Facility

$21.00

Hospital Charge Code	60633710
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PRILOSEC/20MG/CAP

Facility

$15.00

Hospital Charge Code	60633711
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

PRILOSEC/20MG/CAP

Facility

$21.00

Hospital Charge Code	60633710
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

PRIMACOR 1 MG/ML INJ (10 ML)

Facility

$50.25

Service Code	HCPCS J2260
Hospital Charge Code	60635053
Hospital Revenue Code	636
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$15.07
Rate for Payer: Aetna Medicare Advantage	$15.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.81
Rate for Payer: Cigna Commercial	$1.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54

PRIMACOR 1 MG/ML INJ (10 ML)

Facility

$50.25

Service Code	HCPCS J2260
Hospital Charge Code	60635053
Hospital Revenue Code	636
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$12.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54

PRIMADONE I

Facility

$78.70

Hospital Charge Code	39990159A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.80

PRIMADONE I

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39990157A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE I

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39990157A
Hospital Revenue Code	301
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.06
Rate for Payer: Cigna Commercial	$15.30
Rate for Payer: Cigna Medicare Advantage	$7.65
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.22
Rate for Payer: Wellcare Medicare Advantage	$15.30

PRIMADONE I

Facility

$78.70

Hospital Charge Code	39990159A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.61
Rate for Payer: Aetna Medicare Advantage	$23.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.07
Rate for Payer: Cigna Commercial	$39.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

PRIMADONE II

Facility

$390.00

Service Code	HCPCS 80188
Hospital Charge Code	39990157B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE II

Facility

$113.20

Service Code	HCPCS 80188
Hospital Charge Code	39990159B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.79
Rate for Payer: Cigna Commercial	$16.59
Rate for Payer: Cigna Medicare Advantage	$8.29
Rate for Payer: Clover Medicare Advantage	$15.76
Rate for Payer: EmblemHealth Commercial	$49.77
Rate for Payer: Humana Medicare Advantage	$17.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.98
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.59
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.59
Rate for Payer: Wellcare Medicare Advantage	$16.59

PRIMADONE II

Facility

$113.20

Service Code	HCPCS 80188
Hospital Charge Code	39990159B
Hospital Revenue Code	301
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$16.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.98

PRIMADONE II

Facility

$390.00

Service Code	HCPCS 80188
Hospital Charge Code	39990157B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.79
Rate for Payer: Cigna Commercial	$16.59
Rate for Payer: Cigna Medicare Advantage	$8.29
Rate for Payer: Clover Medicare Advantage	$15.76
Rate for Payer: EmblemHealth Commercial	$49.77
Rate for Payer: Humana Medicare Advantage	$17.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.59
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.59
Rate for Payer: Wellcare Medicare Advantage	$16.59

PRIMADONE III

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39990157C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE III

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990159C
Hospital Revenue Code	301
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

PRIMADONE III

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990159C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

PRIMADONE III

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39990157C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

PRIMAQUINE 26.3 MG TAB

Facility

$13.53

Service Code	NDC 24159601
Hospital Charge Code	60627341
Hospital Revenue Code	251
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

Know your out-of-pocket cost for care.

All Charges