Heights University Hospital

All Charges

Charge

Type

Setting

Price

RIFAMPIN 150 MG CAP

Facility

$5.00

Hospital Charge Code	60635695
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

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.73
Rate for Payer: Oxford Commercial	$6.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$6.67

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$6.11
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$10.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$10.19

RIFAMPIN INJ 600MG/10ML

Facility

$658.60

Hospital Charge Code	6009872
Hospital Revenue Code	250
Min. Negotiated Rate	$98.79
Max. Negotiated Rate	$98.79
Rate for Payer: Qualcare PPO/HMO/WC	$98.79

RIFAMPIN INJ 600MG/10ML

Facility

$658.60

Hospital Charge Code	6009872
Hospital Revenue Code	250
Min. Negotiated Rate	$85.62
Max. Negotiated Rate	$329.30
Rate for Payer: Aetna Commercial	$197.58
Rate for Payer: Aetna Medicare Advantage	$197.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.94
Rate for Payer: Cigna Commercial	$329.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.62
Rate for Payer: Oxford Commercial	$329.30
Rate for Payer: Qualcare PPO/HMO/WC	$98.79
Rate for Payer: UnitedHealthcare Commercial	$329.30

RIFATER/TAB

Facility

$8.00

Hospital Charge Code	60634997
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

RIFATER/TAB

Facility

$8.00

Hospital Charge Code	60634997
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$26.86
Max. Negotiated Rate	$103.31
Rate for Payer: Aetna Commercial	$61.99
Rate for Payer: Aetna Medicare Advantage	$61.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.69
Rate for Payer: Cigna Commercial	$103.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.86
Rate for Payer: Oxford Commercial	$103.31
Rate for Payer: Qualcare PPO/HMO/WC	$30.99
Rate for Payer: UnitedHealthcare Commercial	$103.31

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$30.99
Max. Negotiated Rate	$30.99
Rate for Payer: Qualcare PPO/HMO/WC	$30.99

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$17.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.73

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$35.46
Rate for Payer: Aetna Medicare Advantage	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.14
Rate for Payer: Cigna Commercial	$59.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.36
Rate for Payer: Oxford Commercial	$59.09
Rate for Payer: Qualcare PPO/HMO/WC	$17.73
Rate for Payer: UnitedHealthcare Commercial	$59.09

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	74110009
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	366893451
Hospital Revenue Code	481
Min. Negotiated Rate	$1,500.33
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$3,462.30
Rate for Payer: Aetna Medicare Advantage	$3,462.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,942.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,942.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,942.95
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.33
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	7411217
Hospital Revenue Code	481
Min. Negotiated Rate	$1,731.15
Max. Negotiated Rate	$1,731.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	7411217
Hospital Revenue Code	481
Min. Negotiated Rate	$1,500.33
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$3,462.30
Rate for Payer: Aetna Medicare Advantage	$3,462.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,942.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,942.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,942.95
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.33
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	5100045
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	5100045
Hospital Revenue Code	481
Min. Negotiated Rate	$2,104.70
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$4,857.00
Rate for Payer: Aetna Medicare Advantage	$4,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,128.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,128.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,128.45
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,104.70
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	74110009
Hospital Revenue Code	481
Min. Negotiated Rate	$2,104.70
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$4,857.00
Rate for Payer: Aetna Medicare Advantage	$4,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,128.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,128.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,128.45
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,104.70
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	366893451
Hospital Revenue Code	481
Min. Negotiated Rate	$1,731.15
Max. Negotiated Rate	$1,731.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15

RIGIDFIX FEM 3.3MM S/T X PIN

Facility

$2,225.00

Hospital Charge Code	270635268
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$538.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

RIGIDFIX FEM 3.3MM S/T X PIN

Facility

$2,225.00

Hospital Charge Code	270635268
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$667.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

RIGIDFIX FEM GDE FR S/T

Facility

$6,880.00

Hospital Charge Code	270658628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.00
Max. Negotiated Rate	$3,440.00
Rate for Payer: Aetna Commercial	$2,064.00
Rate for Payer: Aetna Medicare Advantage	$2,064.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,754.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,754.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,754.40
Rate for Payer: Cigna Commercial	$3,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,032.00

RIGIDFIX FEM GDE FR S/T

Facility

$6,880.00

Hospital Charge Code	270658628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.00
Max. Negotiated Rate	$1,664.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,032.00

Know your out-of-pocket cost for care.

All Charges