Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROLIXIN DECANOATE/25MG/1

Facility

$383.00

Hospital Charge Code	60633754
Hospital Revenue Code	250
Min. Negotiated Rate	$49.79
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$114.90
Rate for Payer: Aetna Medicare Advantage	$114.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.67
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Oxford Commercial	$191.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
Rate for Payer: UnitedHealthcare Commercial	$191.50

PROLIXIN ENANTHATE/25MG/1

Facility

$565.00

Hospital Charge Code	60633755
Hospital Revenue Code	250
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$84.75
Rate for Payer: Qualcare PPO/HMO/WC	$84.75

PROLIXIN ENANTHATE/25MG/1

Facility

$565.00

Hospital Charge Code	60633755
Hospital Revenue Code	250
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$282.50
Rate for Payer: Aetna Commercial	$169.50
Rate for Payer: Aetna Medicare Advantage	$169.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.07
Rate for Payer: Cigna Commercial	$282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.45
Rate for Payer: Oxford Commercial	$282.50
Rate for Payer: Qualcare PPO/HMO/WC	$84.75
Rate for Payer: UnitedHealthcare Commercial	$282.50

PROLIXIN HCL INJ/10ML

Facility

$235.00

Hospital Charge Code	60634804
Hospital Revenue Code	250
Min. Negotiated Rate	$30.55
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$70.50
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$117.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$117.50

PROLIXIN HCL INJ/10ML

Facility

$235.00

Hospital Charge Code	60634804
Hospital Revenue Code	250
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

PROLIXIN LIQ CONC/120ML

Facility

$473.00

Hospital Charge Code	60634615
Hospital Revenue Code	250
Min. Negotiated Rate	$61.49
Max. Negotiated Rate	$236.50
Rate for Payer: Aetna Commercial	$141.90
Rate for Payer: Aetna Medicare Advantage	$141.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.61
Rate for Payer: Cigna Commercial	$236.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.49
Rate for Payer: Oxford Commercial	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.95
Rate for Payer: UnitedHealthcare Commercial	$236.50

PROLIXIN LIQ CONC/120ML

Facility

$473.00

Hospital Charge Code	60634615
Hospital Revenue Code	250
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$70.95
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

PROLOID/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633756
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

PROLOID/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$2,775.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$143.50
Rate for Payer: Aetna Commercial	$86.10
Rate for Payer: Aetna Medicare Advantage	$86.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.19
Rate for Payer: Cigna Commercial	$143.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.31
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

PROLONGED VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99213WF
Hospital Charge Code	9600014
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

PROLONGED VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99213WF
Hospital Charge Code	9600014
Hospital Revenue Code	519
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$7.59
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$98.37
Max. Negotiated Rate	$378.33
Rate for Payer: Aetna Commercial	$227.00
Rate for Payer: Aetna Medicare Advantage	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.95
Rate for Payer: Cigna Commercial	$378.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.37
Rate for Payer: Oxford Commercial	$378.33
Rate for Payer: Qualcare PPO/HMO/WC	$113.50
Rate for Payer: UnitedHealthcare Commercial	$378.33

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$113.50
Rate for Payer: Qualcare PPO/HMO/WC	$113.50

PROMETHAZINE 12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635690
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

PROMETHAZINE 12.5MG/10ML

Facility

$2.00

Hospital Charge Code	60635690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PROMETHAZINE 12.5 MG SUPP

Facility

$118.66

Service Code	NDC 713053612
Hospital Charge Code	60627859
Hospital Revenue Code	250
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

PROMETHAZINE 12.5 MG SUPP

Facility

$118.66

Service Code	NDC 713053612
Hospital Charge Code	60627859
Hospital Revenue Code	250
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$59.33
Rate for Payer: Aetna Commercial	$35.60
Rate for Payer: Aetna Medicare Advantage	$35.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.26
Rate for Payer: Cigna Commercial	$59.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$59.33
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$59.33

PROMETHAZINE 12.5MG TAB

Facility

$4.00

Service Code	HCPCS Q0169
Hospital Charge Code	6063943163
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROMETHAZINE 12.5MG TAB

Facility

$4.00

Service Code	HCPCS Q0169
Hospital Charge Code	6063943163
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROMETHAZINE/25MG/1ML

Facility

$7.00

Hospital Charge Code	60633757
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PROMETHAZINE/25MG/1ML

Facility

$7.00

Hospital Charge Code	60633757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

Know your out-of-pocket cost for care.

All Charges