Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROPULSID/10MG/TAB

Facility

$4.00

Hospital Charge Code	60634911
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

PROPULSID/20MG

Facility

$5.00

Hospital Charge Code	60634969
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PROPULSID/20MG

Facility

$5.00

Hospital Charge Code	60634969
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

PROPYLTHIOURACIL 50 MG TAB

Facility

$6.03

Service Code	NDC 480924201
Hospital Charge Code	60628266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.02

PROPYLTHIOURACIL 50 MG TAB

Facility

$6.03

Service Code	NDC 480924201
Hospital Charge Code	60628266
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROPYLTHIOURACIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633766
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROPYLTHIOURACIL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633766
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

PROPYLTHIOURACIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633765
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PROPYLTHIOURACIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633765
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

PROQUAD 0.5ML VIAL

Facility

$1,217.46

Service Code	HCPCS 90710
Hospital Charge Code	83652587
Hospital Revenue Code	636
Min. Negotiated Rate	$182.62
Max. Negotiated Rate	$294.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.63
Rate for Payer: Qualcare PPO/HMO/WC	$182.62

PROQUAD 0.5ML VIAL

Facility

$1,217.46

Service Code	HCPCS 90710
Hospital Charge Code	83652587
Hospital Revenue Code	636
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$608.73
Rate for Payer: Aetna Commercial	$365.24
Rate for Payer: Aetna Medicare Advantage	$365.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.45
Rate for Payer: Cigna Commercial	$608.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.63
Rate for Payer: Qualcare PPO/HMO/WC	$182.62

PROSHEATINTRO4FR11CM0.035X50RE

Facility

$46.50

Hospital Charge Code	2709006379
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO4FR11CM0.035X50RE

Facility

$46.50

Hospital Charge Code	2709006379
Hospital Revenue Code	272
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.25

PROSHEATINTRO6FR11CM0.035X50GR

Facility

$46.50

Hospital Charge Code	2709006381
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO6FR11CM0.035X50GR

Facility

$46.50

Hospital Charge Code	2709006381
Hospital Revenue Code	272
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.25

PROSHEATINTRO7FR11CM0.035X50OR

Facility

$46.50

Hospital Charge Code	2709006382
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PROSHEATINTRO7FR11CM0.035X50OR

Facility

$46.50

Hospital Charge Code	2709006382
Hospital Revenue Code	272
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.25

PROSHEATINTRO8FR11CM0.035X50BL

Facility

$47.50

Hospital Charge Code	2709006383
Hospital Revenue Code	272
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$23.75

PROSHEATINTRO8FR11CM0.035X50BL

Facility

$47.50

Hospital Charge Code	2709006383
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

PROSHIELD PLUS SPRAY

Facility

$49.85

Service Code	NDC 64015008
Hospital Charge Code	6063943165
Hospital Revenue Code	250
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$7.48

PROSHIELD PLUS SPRAY

Facility

$49.85

Service Code	NDC 64015008
Hospital Charge Code	6063943165
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$24.93
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.71
Rate for Payer: Cigna Commercial	$24.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.48
Rate for Payer: Oxford Commercial	$24.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.48
Rate for Payer: UnitedHealthcare Commercial	$24.93

PROS McGEE PISTONS MALL1156348

Facility

$405.00

Hospital Charge Code	270640806
Hospital Revenue Code	272
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$202.50

PROS McGEE PISTONS MALL1156348

Facility

$405.00

Hospital Charge Code	270640806
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

PROSPERA IPG

Facility

$100,000.00

Service Code	HCPCS C1820
Hospital Charge Code	270705872
Hospital Revenue Code	278
Min. Negotiated Rate	$15,000.00
Max. Negotiated Rate	$50,000.00
Rate for Payer: Aetna Commercial	$30,000.00
Rate for Payer: Aetna Medicare Advantage	$30,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,500.00
Rate for Payer: Cigna Commercial	$50,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,000.00

PROSPERA IPG

Facility

$100,000.00

Service Code	HCPCS C1820
Hospital Charge Code	270705872
Hospital Revenue Code	278
Min. Negotiated Rate	$15,000.00
Max. Negotiated Rate	$24,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,000.00

Know your out-of-pocket cost for care.

All Charges