Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROLACTIN&MONOMERIC II

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROLACTIN&MONOMERIC II

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.79
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$71.01
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: Cigna Medicare Advantage	$9.69
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
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	$19.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.54
Rate for Payer: Wellcare Medicare Advantage	$19.38

PROLACTIN TOTAL&MONOMERIC

Facility

$288.25

Service Code	HCPCS 84146
Hospital Charge Code	401184146A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.79
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$71.01
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: Cigna Medicare Advantage	$9.69
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.24
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.54
Rate for Payer: Wellcare Medicare Advantage	$19.38

PROLACTIN TOTAL&MONOMERIC

Facility

$288.25

Service Code	HCPCS 84146
Hospital Charge Code	401184146A
Hospital Revenue Code	301
Min. Negotiated Rate	$43.24
Max. Negotiated Rate	$43.24
Rate for Payer: Qualcare PPO/HMO/WC	$43.24

PROLENE MESH

Facility

$299.00

Hospital Charge Code	270335105
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$149.50
Rate for Payer: Aetna Commercial	$89.70
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

PROLENE MESH

Facility

$299.00

Hospital Charge Code	270335105
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

PROLIFT LATERAL 18X55X10 7DEG

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694228
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

PROLIFT LATERAL 18X55X10 7DEG

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694228
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$11,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

PROLITE MESH II

Facility

$152.70

Service Code	HCPCS C1781
Hospital Charge Code	270653387
Hospital Revenue Code	278
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$36.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.91

PROLITE MESH II

Facility

$152.70

Service Code	HCPCS C1781
Hospital Charge Code	270653387
Hospital Revenue Code	278
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$76.35
Rate for Payer: Aetna Commercial	$45.81
Rate for Payer: Aetna Medicare Advantage	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.94
Rate for Payer: Cigna Commercial	$76.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.91

PROLIXIN/10MG/TAB

Facility

$9.00

Hospital Charge Code	60633753
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROLIXIN/10MG/TAB

Facility

$9.00

Hospital Charge Code	60633753
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PROLIXIN/1MG/TAB

Facility

$5.00

Hospital Charge Code	60633752
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PROLIXIN/1MG/TAB

Facility

$5.00

Hospital Charge Code	60633752
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

PROLIXIN 2.5MG/5ML

Facility

$2.00

Hospital Charge Code	60635686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

PROLIXIN 2.5MG/5ML

Facility

$2.00

Hospital Charge Code	60635686
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PROLIXIN/2.5MG/5ML

Facility

$645.00

Hospital Charge Code	60633751
Hospital Revenue Code	250
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.85
Rate for Payer: Oxford Commercial	$322.50
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Commercial	$322.50

PROLIXIN/2.5MG/5ML

Facility

$645.00

Hospital Charge Code	60633751
Hospital Revenue Code	250
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

PROLIXIN 25 MG/ML VIAL

Facility

$167.25

Service Code	HCPCS J2680
Hospital Charge Code	87504145
Hospital Revenue Code	636
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$50.17
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.65
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.47
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

PROLIXIN 25 MG/ML VIAL

Facility

$167.25

Service Code	HCPCS J2680
Hospital Charge Code	87504145
Hospital Revenue Code	636
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$40.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.47
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

PROLIXIN/2.5MG/TAB

Facility

$9.00

Hospital Charge Code	60633750
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROLIXIN/2.5MG/TAB

Facility

$9.00

Hospital Charge Code	60633750
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PROLIXIN/5MG/TAB

Facility

$9.00

Hospital Charge Code	60633749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PROLIXIN/5MG/TAB

Facility

$9.00

Hospital Charge Code	60633749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROLIXIN DECANOATE/25MG/1

Facility

$383.00

Hospital Charge Code	60633754
Hospital Revenue Code	250
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

Know your out-of-pocket cost for care.

All Charges