Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRIMAQUINE 26.3 MG TAB

Facility

$13.53

Service Code	NDC 24159601
Hospital Charge Code	60627341
Hospital Revenue Code	251
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$6.76
Rate for Payer: Aetna Commercial	$4.06
Rate for Payer: Aetna Medicare Advantage	$4.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.45
Rate for Payer: Cigna Commercial	$6.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Oxford Commercial	$6.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$6.76

PRIMAQUINE/26.3MG/TAB

Facility

$4.00

Hospital Charge Code	60633712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PRIMAQUINE/26.3MG/TAB

Facility

$4.00

Hospital Charge Code	60633712
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PRIM ART M-THRMBC 1ST VSL

Facility

$20,340.00

Service Code	HCPCS 37184
Hospital Charge Code	1600000735
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

PRIM ART M-THRMBC 1ST VSL

Facility

$20,340.00

Service Code	HCPCS 37184
Hospital Charge Code	1600000735
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$6,102.00
Rate for Payer: Aetna Medicare Advantage	$6,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,186.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,186.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,186.70
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,644.20
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRIMARY FEMORAL PC STEM 16X152

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PRIMARY FEMORAL PC STEM 16X152

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PRIMARY SET W/CHECK VALVE***

Facility

$21.00

Hospital Charge Code	8010001
Hospital Revenue Code	279
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

PRIMARY SET W/CHECK VALVE***

Facility

$21.00

Hospital Charge Code	8010001
Hospital Revenue Code	279
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PRIMARY STEM TM 12MM STANDA

Facility

$21,430.00

Hospital Charge Code	270667177
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$10,715.00
Rate for Payer: Aetna Commercial	$6,429.00
Rate for Payer: Aetna Medicare Advantage	$6,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.65
Rate for Payer: Cigna Commercial	$10,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

PRIMARY STEM TM 12MM STANDA

Facility

$21,430.00

Hospital Charge Code	270667177
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$5,186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

PRIMARY STEM TM 14MM STANDARD

Facility

$21,427.75

Hospital Charge Code	270667174
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.16
Max. Negotiated Rate	$5,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16

PRIMARY STEM TM 14MM STANDARD

Facility

$21,427.75

Hospital Charge Code	270667174
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.16
Max. Negotiated Rate	$10,713.88
Rate for Payer: Aetna Commercial	$6,428.32
Rate for Payer: Aetna Medicare Advantage	$6,428.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.08
Rate for Payer: Cigna Commercial	$10,713.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	411037184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,526.72
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	411037184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	7411123
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	366837184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,526.72
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	7411123
Hospital Revenue Code	361
Min. Negotiated Rate	$1,526.72
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	366837184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

PRIMATENE MIST/0.2MG/15ML

Facility

$61.00

Hospital Charge Code	60633713
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

PRIMATENE MIST/0.2MG/15ML

Facility

$61.00

Hospital Charge Code	60633713
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

PRIMATRIX AG 8X8CM

Facility

$12,412.55

Service Code	HCPCS Q4110
Hospital Charge Code	270689627
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,723.76
Rate for Payer: Aetna Commercial	$3,723.76
Rate for Payer: Aetna Medicare Advantage	$3,723.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,165.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,165.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,165.20
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,003.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.88

PRIMATRIX AG 8X8CM

Facility

$12,412.55

Service Code	HCPCS Q4110
Hospital Charge Code	270689627
Hospital Revenue Code	636
Min. Negotiated Rate	$1,861.88
Max. Negotiated Rate	$3,003.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,003.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.88

PRIMATRIX MESHED 10 X 25CM

Facility

$22,370.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684234
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$6,711.00
Rate for Payer: Aetna Commercial	$6,711.00
Rate for Payer: Aetna Medicare Advantage	$6,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,474.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,704.35
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

PRIMATRIX MESHED 10 X 25CM

Facility

$22,370.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684234
Hospital Revenue Code	278
Min. Negotiated Rate	$3,355.50
Max. Negotiated Rate	$5,413.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,474.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

Know your out-of-pocket cost for care.

All Charges