Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRINIVIL 5MG

Facility

$6.00

Hospital Charge Code	60635076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PRINIVIL 5MG

Facility

$6.00

Hospital Charge Code	60635076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

PRINIVIL 5MG U/D

Facility

$5.00

Hospital Charge Code	60635077
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PRINIVIL 5MG U/D

Facility

$5.00

Hospital Charge Code	60635077
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

PRINTER DISCMONITOR CHARGES

Facility

$2,500.00

Hospital Charge Code	270648672
Hospital Revenue Code	270
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

PRINTER DISCMONITOR CHARGES

Facility

$2,500.00

Hospital Charge Code	270648672
Hospital Revenue Code	270
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$1,250.00

PRINT PACK COLOR SONY

Facility

$5.44

Hospital Charge Code	270654310
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

PRINT PACK COLOR SONY

Facility

$5.44

Hospital Charge Code	270654310
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.39
Rate for Payer: Cigna Commercial	$2.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.82
Rate for Payer: UnitedHealthcare Commercial	$2.72

PRIVATE ROOM DIFFERENTIAL

Facility

$269.10

Hospital Charge Code	110001
Hospital Revenue Code	110
Min. Negotiated Rate	$40.37
Max. Negotiated Rate	$6,764.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,764.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.37

PRIVER

Facility

$240.00

Hospital Charge Code	270667013
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

PRIVER

Facility

$240.00

Hospital Charge Code	270667013
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

PRIVIGEN 10GM

Facility

$2,982.00

Hospital Charge Code	60635719
Hospital Revenue Code	636
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$1,491.00
Rate for Payer: Aetna Commercial	$894.60
Rate for Payer: Aetna Medicare Advantage	$894.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$760.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$760.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$760.41
Rate for Payer: Cigna Commercial	$1,491.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.64
Rate for Payer: Qualcare PPO/HMO/WC	$447.30

PRIVIGEN 10GM

Facility

$2,982.00

Hospital Charge Code	60635719
Hospital Revenue Code	636
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$721.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.64
Rate for Payer: Qualcare PPO/HMO/WC	$447.30

PRIVIGEN 20GM

Facility

$5,963.00

Hospital Charge Code	60635720
Hospital Revenue Code	636
Min. Negotiated Rate	$894.45
Max. Negotiated Rate	$2,981.50
Rate for Payer: Aetna Commercial	$1,788.90
Rate for Payer: Aetna Medicare Advantage	$1,788.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,520.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,520.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,520.57
Rate for Payer: Cigna Commercial	$2,981.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,443.05
Rate for Payer: Qualcare PPO/HMO/WC	$894.45

PRIVIGEN 20GM

Facility

$5,963.00

Hospital Charge Code	60635720
Hospital Revenue Code	636
Min. Negotiated Rate	$894.45
Max. Negotiated Rate	$1,443.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,443.05
Rate for Payer: Qualcare PPO/HMO/WC	$894.45

PRNLG SRV IP ADDTL 30 MINS

Facility

$289.00

Service Code	HCPCS 99357
Hospital Charge Code	87502365
Hospital Revenue Code	510
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$144.50
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare Advantage	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.69
Rate for Payer: Cigna Commercial	$144.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.57
Rate for Payer: Qualcare PPO/HMO/WC	$43.35

PRNLG SRV IP ADDTL 30 MINS

Facility

$289.00

Service Code	HCPCS 99357
Hospital Charge Code	87502365
Hospital Revenue Code	510
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.35

PRO-3 AB

Facility

$205.65

Service Code	HCPCS 86021
Hospital Charge Code	3035096
Hospital Revenue Code	300
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	$16.83
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	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
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

PRO-3 AB

Facility

$205.65

Service Code	HCPCS 86021
Hospital Charge Code	3035096
Hospital Revenue Code	300
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

PRO AIR HFA

Facility

$589.33

Service Code	NDC 59310057922
Hospital Charge Code	6063943276
Hospital Revenue Code	250
Min. Negotiated Rate	$76.61
Max. Negotiated Rate	$294.67
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna Medicare Advantage	$176.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.28
Rate for Payer: Cigna Commercial	$294.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.61
Rate for Payer: Oxford Commercial	$294.67
Rate for Payer: Qualcare PPO/HMO/WC	$88.40
Rate for Payer: UnitedHealthcare Commercial	$294.67

PRO AIR HFA

Facility

$589.33

Service Code	NDC 59310057922
Hospital Charge Code	6063943276
Hospital Revenue Code	250
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$88.40
Rate for Payer: Qualcare PPO/HMO/WC	$88.40

PRO-BANTHINE/15MG/TAB

Facility

$3.00

Hospital Charge Code	60634392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PRO-BANTHINE/15MG/TAB

Facility

$3.00

Hospital Charge Code	60634392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PRO-BANTHINE/7.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PRO-BANTHINE/7.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges