Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRIMATRIX PERF 4x4CM

Facility

$3,423.00

Service Code	HCPCS Q4110
Hospital Charge Code	270674002
Hospital Revenue Code	278
Min. Negotiated Rate	$513.45
Max. Negotiated Rate	$828.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.37
Rate for Payer: Qualcare PPO/HMO/WC	$513.45

PRIMATRIX PERF 4x4CM

Facility

$3,423.00

Service Code	HCPCS Q4110
Hospital Charge Code	270674002
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,026.90
Rate for Payer: Aetna Commercial	$1,026.90
Rate for Payer: Aetna Medicare Advantage	$1,026.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.87
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.37
Rate for Payer: Qualcare PPO/HMO/WC	$513.45

PRIMATRIX PERF 4x4CM/SQ CM JW

Facility

$855.75

Hospital Charge Code	270674002W
Hospital Revenue Code	636
Min. Negotiated Rate	$128.36
Max. Negotiated Rate	$207.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.09
Rate for Payer: Qualcare PPO/HMO/WC	$128.36

PRIMATRIX PERF 4x4CM/SQ CM JW

Facility

$855.75

Hospital Charge Code	270674002W
Hospital Revenue Code	636
Min. Negotiated Rate	$128.36
Max. Negotiated Rate	$427.88
Rate for Payer: Aetna Commercial	$256.73
Rate for Payer: Aetna Medicare Advantage	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.22
Rate for Payer: Cigna Commercial	$427.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.09
Rate for Payer: Qualcare PPO/HMO/WC	$128.36

PRIMAXIN/250MG

Facility

$53.00

Hospital Charge Code	60633714
Hospital Revenue Code	636
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

PRIMAXIN/250MG

Facility

$53.00

Hospital Charge Code	60633714
Hospital Revenue Code	636
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$15.90
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

PRIMAXIN/250MG

Facility

$71.00

Hospital Charge Code	60633716
Hospital Revenue Code	636
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PRIMAXIN/250MG

Facility

$71.00

Hospital Charge Code	60633716
Hospital Revenue Code	636
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$17.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.18
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PRIMAXIN/500MG

Facility

$324.00

Hospital Charge Code	60633718
Hospital Revenue Code	636
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

PRIMAXIN/500MG

Facility

$355.00

Hospital Charge Code	60633715
Hospital Revenue Code	636
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

PRIMAXIN/500MG

Facility

$324.00

Hospital Charge Code	60633718
Hospital Revenue Code	636
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$78.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

PRIMAXIN/500MG

Facility

$355.00

Hospital Charge Code	60633715
Hospital Revenue Code	636
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

PRIMAXIN ADDVANT/500MG

Facility

$150.00

Hospital Charge Code	60634289
Hospital Revenue Code	636
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PRIMAXIN ADDVANT/500MG

Facility

$150.00

Hospital Charge Code	60634289
Hospital Revenue Code	636
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PRIMAXIN IM 500MG

Facility

$141.00

Hospital Charge Code	60635711
Hospital Revenue Code	636
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$34.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

PRIMAXIN IM 500MG

Facility

$141.00

Hospital Charge Code	60635711
Hospital Revenue Code	636
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

PRIMAXIN I.V./500MG

Facility

$324.00

Hospital Charge Code	60633719
Hospital Revenue Code	636
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

PRIMAXIN I.V./500MG

Facility

$324.00

Hospital Charge Code	60633719
Hospital Revenue Code	636
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$78.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.41
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

PRIME ADVANCED 37702

Facility

$76,200.00

Service Code	HCPCS C1767
Hospital Charge Code	270640283
Hospital Revenue Code	278
Min. Negotiated Rate	$11,430.00
Max. Negotiated Rate	$18,440.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,440.40
Rate for Payer: Qualcare PPO/HMO/WC	$11,430.00

PRIME ADVANCED 37702

Facility

$76,200.00

Service Code	HCPCS C1767
Hospital Charge Code	270640283
Hospital Revenue Code	278
Min. Negotiated Rate	$11,430.00
Max. Negotiated Rate	$38,100.00
Rate for Payer: Aetna Commercial	$22,860.00
Rate for Payer: Aetna Medicare Advantage	$22,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,431.00
Rate for Payer: Cigna Commercial	$38,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,440.40
Rate for Payer: Qualcare PPO/HMO/WC	$11,430.00

PRIMIDONE 250 MG TAB

Facility

$6.70

Service Code	NDC 527123101
Hospital Charge Code	60627738
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

PRIMIDONE 250 MG TAB

Facility

$6.70

Service Code	NDC 527123101
Hospital Charge Code	60627738
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.87
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$3.35

PRIMIDONE 50 MG TAB

Facility

$4.00

Service Code	NDC 527130101
Hospital Charge Code	60627739
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

PRIMIDONE 50 MG TAB

Facility

$4.00

Service Code	NDC 527130101
Hospital Charge Code	60627739
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PRIMIDONE (MYSOLINE)

Facility

$384.00

Service Code	HCPCS 80188
Hospital Charge Code	38472557
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	$49.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
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

Know your out-of-pocket cost for care.

All Charges