Heights University Hospital

All Charges

Charge

Type

Setting

Price

RANITADINE TAB 150MG

Facility

$10.90

Hospital Charge Code	6010243
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

RANITADINE TAB 150MG

Facility

$10.90

Hospital Charge Code	6010243
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

RANITIDINE 150MG CAPSULE

Facility

$9.92

Service Code	NDC 27241010950
Hospital Charge Code	606390300
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

RANITIDINE 150MG CAPSULE

Facility

$9.92

Service Code	NDC 27241010950
Hospital Charge Code	606390300
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$4.96
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare Advantage	$2.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.53
Rate for Payer: Cigna Commercial	$4.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.29
Rate for Payer: Oxford Commercial	$4.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$4.96

RANITIDINE BISMUTH TAB 400MG

Facility

$12.80

Hospital Charge Code	60628696
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

RANITIDINE BISMUTH TAB 400MG

Facility

$12.80

Hospital Charge Code	60628696
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

RANITIDINE INJ 25MG/ML 2ML

Facility

$21.15

Hospital Charge Code	6004782
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

RANITIDINE INJ 25MG/ML 2ML

Facility

$21.15

Hospital Charge Code	6004782
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

RANITIDINE IVPB 50MG/50ML D5W

Facility

$25.60

Hospital Charge Code	60628173
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

RANITIDINE IVPB 50MG/50ML D5W

Facility

$25.60

Hospital Charge Code	60628173
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

RANITIDINE IVPB 50MG/50ML NS

Facility

$32.00

Hospital Charge Code	60628174
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

RANITIDINE IVPB 50MG/50ML NS

Facility

$32.00

Hospital Charge Code	60628174
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

RANITIDINE SYRUP 150MG

Facility

$54.34

Service Code	NDC 68094020459
Hospital Charge Code	60635067
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$27.17
Rate for Payer: Aetna Commercial	$16.30
Rate for Payer: Aetna Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.86
Rate for Payer: Cigna Commercial	$27.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.06
Rate for Payer: Oxford Commercial	$27.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.15
Rate for Payer: UnitedHealthcare Commercial	$27.17

RANITIDINE SYRUP 150MG

Facility

$54.34

Service Code	NDC 68094020459
Hospital Charge Code	60635067
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$8.15
Rate for Payer: Qualcare PPO/HMO/WC	$8.15

RANITIDINE SYRUP 15MG/ML 120ML

Facility

$4.85

Hospital Charge Code	6010607
Hospital Revenue Code	252
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

RANITIDINE SYRUP 15MG/ML 120ML

Facility

$4.85

Hospital Charge Code	6010607
Hospital Revenue Code	252
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

RANITIDINE SYRUP U/D

Facility

$30.00

Hospital Charge Code	60635673
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

RANITIDINE SYRUP U/D

Facility

$30.00

Hospital Charge Code	60635673
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

RANOLAZINE 200MG CAP

Facility

$149.15

Hospital Charge Code	6063943169
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$22.37
Rate for Payer: Qualcare PPO/HMO/WC	$22.37

RANOLAZINE 200MG CAP

Facility

$149.15

Hospital Charge Code	6063943169
Hospital Revenue Code	250
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$74.58
Rate for Payer: Aetna Commercial	$44.74
Rate for Payer: Aetna Medicare Advantage	$44.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.03
Rate for Payer: Cigna Commercial	$74.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.39
Rate for Payer: Oxford Commercial	$74.58
Rate for Payer: Qualcare PPO/HMO/WC	$22.37
Rate for Payer: UnitedHealthcare Commercial	$74.58

RAPID FLU A AND B

Facility

$629.98

Service Code	HCPCS 87804
Hospital Charge Code	3036053
Hospital Revenue Code	306
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

RAPID FLU A AND B

Facility

$629.98

Service Code	HCPCS 87804
Hospital Charge Code	3036053
Hospital Revenue Code	306
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.62
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: Cigna Medicare Advantage	$8.28
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.54
Rate for Payer: Wellcare Medicare Advantage	$16.55

RAPID PLASMA REAGIN (RPR),QT

Facility

$141.00

Service Code	HCPCS 86593
Hospital Charge Code	38476024
Hospital Revenue Code	302
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.26
Rate for Payer: Aetna Medicare Advantage	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.12
Rate for Payer: Cigna Commercial	$4.40
Rate for Payer: Cigna Medicare Advantage	$2.20
Rate for Payer: Clover Medicare Advantage	$4.18
Rate for Payer: EmblemHealth Commercial	$13.20
Rate for Payer: Humana Medicare Advantage	$4.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.66
Rate for Payer: Wellcare Medicare Advantage	$4.40

RAPID PLASMA REAGIN (RPR),QT

Facility

$141.00

Service Code	HCPCS 86593
Hospital Charge Code	38476024
Hospital Revenue Code	302
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

RAPID RHINO 5.5 NON-INF

Facility

$155.00

Hospital Charge Code	270654032
Hospital Revenue Code	272
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.15
Rate for Payer: Oxford Commercial	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Commercial	$77.50

Know your out-of-pocket cost for care.

All Charges