Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$367.67
Max. Negotiated Rate	$1,414.10
Rate for Payer: Aetna Commercial	$848.46
Rate for Payer: Aetna Medicare Advantage	$848.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$721.19
Rate for Payer: Cigna Commercial	$1,414.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.67
Rate for Payer: Oxford Commercial	$1,414.10
Rate for Payer: Qualcare PPO/HMO/WC	$424.23
Rate for Payer: UnitedHealthcare Commercial	$1,414.10

PROSTIN E2 2MG VAG SUPP

Facility

$122.00

Hospital Charge Code	60634779
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$36.60
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$61.00

PROSTIN E2 2MG VAG SUPP

Facility

$122.00

Hospital Charge Code	60634779
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$1,642.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$198.63
Max. Negotiated Rate	$198.63
Rate for Payer: Qualcare PPO/HMO/WC	$198.63

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$172.15
Max. Negotiated Rate	$662.11
Rate for Payer: Aetna Commercial	$397.27
Rate for Payer: Aetna Medicare Advantage	$397.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.68
Rate for Payer: Cigna Commercial	$662.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.15
Rate for Payer: Oxford Commercial	$662.11
Rate for Payer: Qualcare PPO/HMO/WC	$198.63
Rate for Payer: UnitedHealthcare Commercial	$662.11

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$112.58
Max. Negotiated Rate	$433.00
Rate for Payer: Aetna Commercial	$259.80
Rate for Payer: Aetna Medicare Advantage	$259.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.83
Rate for Payer: Cigna Commercial	$433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.58
Rate for Payer: Oxford Commercial	$433.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.90
Rate for Payer: UnitedHealthcare Commercial	$433.00

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$129.90
Max. Negotiated Rate	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$129.90

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
Hospital Revenue Code	636
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$21.71
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.45
Rate for Payer: Cigna Commercial	$1.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
Hospital Revenue Code	636
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$17.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

PROTAMINE SULFATE***

Facility

$163.00

Hospital Charge Code	3032497
Hospital Revenue Code	309
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.90
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$114.00

PROTAMINE SULFATE***

Facility

$163.00

Hospital Charge Code	3032497
Hospital Revenue Code	309
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633772
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULFATE/10MG/1M

Facility

$24.00

Hospital Charge Code	60633771
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.20
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633770
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633770
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULFATE/10MG/1M

Facility

$24.00

Hospital Charge Code	60633771
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$5.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

PROTAMINE SULFATE/10MG/1M

Facility

$23.00

Hospital Charge Code	60633772
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PROTAMINE SULF VL 50MG

Facility

$9.00

Hospital Charge Code	6013171
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

PROTAMINE SULF VL 50MG

Facility

$9.00

Hospital Charge Code	6013171
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROTECTIVE ANGIOCATHS ********

Facility

$6.00

Hospital Charge Code	8003527
Hospital Revenue Code	279
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

PROTECTIVE ANGIOCATHS ********

Facility

$6.00

Hospital Charge Code	8003527
Hospital Revenue Code	279
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROTECTOR ALEXIS WND PROTECTOR

Facility

$270.00

Hospital Charge Code	270688645
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

PROTECTOR ALEXIS WND PROTECTOR

Facility

$270.00

Hospital Charge Code	270688645
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

Know your out-of-pocket cost for care.

All Charges