Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROCHLORPERAZINE 5MG ORAL

Facility

$7.00

Hospital Charge Code	60632733
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PROCHLORPERAZINE 5 MG TAB

Facility

$4.09

Service Code	HCPCS J8597
Hospital Charge Code	60629225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

PROCHLORPERAZINE 5 MG TAB

Facility

$4.09

Service Code	HCPCS J8597
Hospital Charge Code	60629225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.04
Rate for Payer: Aetna Commercial	$1.23
Rate for Payer: Aetna Medicare Advantage	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.04
Rate for Payer: Cigna Commercial	$2.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

PROCHLORPERAZINE EDISYLAT

Facility

$18.00

Hospital Charge Code	60633745
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

PROCHLORPERAZINE EDISYLAT

Facility

$18.00

Hospital Charge Code	60633745
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

PROCHLORPERAZINE INJ 10MG/2ML*

Facility

$1.84

Service Code	HCPCS J0780
Hospital Charge Code	60628148P
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$3.33
Rate for Payer: Aetna Commercial	$0.55
Rate for Payer: Aetna Medicare Advantage	$0.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.47
Rate for Payer: Cigna Commercial	$3.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.28

PROCHLORPERAZINE INJ 10MG/2ML*

Facility

$1.84

Service Code	HCPCS J0780
Hospital Charge Code	60628148P
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.28

PROCHLORPERAZINE TAB 5MG

Facility

$4.50

Hospital Charge Code	6014161
Hospital Revenue Code	251
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

PROCHLORPERAZINE TAB 5MG

Facility

$4.50

Hospital Charge Code	6014161
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

PROCISE MAX PLASMA WAND

Facility

$1,250.00

Hospital Charge Code	270655896
Hospital Revenue Code	271
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

PROCISE MAX PLASMA WAND

Facility

$1,250.00

Hospital Charge Code	270655896
Hospital Revenue Code	271
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$18,141.00
Max. Negotiated Rate	$29,267.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$18,141.00
Max. Negotiated Rate	$60,470.00
Rate for Payer: Aetna Commercial	$36,282.00
Rate for Payer: Aetna Medicare Advantage	$36,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,839.70
Rate for Payer: Cigna Commercial	$60,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$1,313.00
Max. Negotiated Rate	$5,050.00
Rate for Payer: Aetna Commercial	$3,030.00
Rate for Payer: Aetna Medicare Advantage	$3,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,575.50
Rate for Payer: Cigna Commercial	$5,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,313.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$2,979.00

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$3,433.68
Max. Negotiated Rate	$3,433.68
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$1,825.81
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$6,867.36
Rate for Payer: Aetna Medicare Advantage	$6,867.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,837.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,837.26
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	$5,837.26
Rate for Payer: Cigna Commercial	$1,825.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,975.86
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PROCTOCORT 1%/30GM

Facility

$80.00

Hospital Charge Code	60633746
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

PROCTOCORT 1%/30GM

Facility

$80.00

Hospital Charge Code	60633746
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

PROCTOSCOPY***

Facility

$190.00

Service Code	HCPCS 45300
Hospital Charge Code	2300408
Hospital Revenue Code	759
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$2,214.60
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PROCTOSCOPY***

Facility

$190.00

Service Code	HCPCS 45300
Hospital Charge Code	2300408
Hospital Revenue Code	759
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PROCTOSCOPY W/ANAL DILATAT***

Facility

$221.00

Service Code	HCPCS 99999
Hospital Charge Code	2300440
Hospital Revenue Code	759
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

PROCTOSCOPY W/ANAL DILATAT***

Facility

$221.00

Service Code	HCPCS 99999
Hospital Charge Code	2300440
Hospital Revenue Code	759
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.73
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

PROCTOSCOPY WITH IRC***

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300416
Hospital Revenue Code	759
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$42.45
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

PROCTOSCOPY WITH IRC***

Facility

$283.00

Service Code	HCPCS 99999
Hospital Charge Code	2300416
Hospital Revenue Code	759
Min. Negotiated Rate	$36.79
Max. Negotiated Rate	$141.50
Rate for Payer: Aetna Commercial	$84.90
Rate for Payer: Aetna Medicare Advantage	$84.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.17
Rate for Payer: Cigna Commercial	$141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.79
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

Know your out-of-pocket cost for care.

All Charges