Heights University Hospital

All Charges

Charge

Type

Setting

Price

RING VALTRAC 31X1.5 8089-00**

Facility

$897.00

Hospital Charge Code	1604305
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 31X1.5 8089-00**

Facility

$897.00

Hospital Charge Code	1604305
Hospital Revenue Code	272
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$269.10
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.61
Rate for Payer: Oxford Commercial	$448.50
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$448.50

RING VALTRAC 31X2.0 80900-00**

Facility

$897.00

Hospital Charge Code	1604313
Hospital Revenue Code	272
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$269.10
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.61
Rate for Payer: Oxford Commercial	$448.50
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$448.50

RING VALTRAC 31X2.0 80900-00**

Facility

$897.00

Hospital Charge Code	1604313
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RIOPAN/540MG/5ML

Facility

$3.00

Hospital Charge Code	60633825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

RIOPAN/540MG/5ML

Facility

$3.00

Hospital Charge Code	60633825
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

RIOPAN PLUS

Facility

$6.00

Hospital Charge Code	60634435
Hospital Revenue Code	250
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

RIOPAN PLUS

Facility

$6.00

Hospital Charge Code	60634435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

RIO SYSTEM IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270692852
Hospital Revenue Code	272
Min. Negotiated Rate	$78.16
Max. Negotiated Rate	$300.62
Rate for Payer: Aetna Commercial	$180.38
Rate for Payer: Aetna Medicare Advantage	$180.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.32
Rate for Payer: Cigna Commercial	$300.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.16
Rate for Payer: Oxford Commercial	$300.62
Rate for Payer: Qualcare PPO/HMO/WC	$90.19
Rate for Payer: UnitedHealthcare Commercial	$300.62

RIO SYSTEM IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270692852
Hospital Revenue Code	272
Min. Negotiated Rate	$90.19
Max. Negotiated Rate	$90.19
Rate for Payer: Qualcare PPO/HMO/WC	$90.19

RISEDRONATE 30 MG TAB

Facility

$28.90

Hospital Charge Code	60629237
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$14.45
Rate for Payer: Aetna Commercial	$8.67
Rate for Payer: Aetna Medicare Advantage	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.37
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.76
Rate for Payer: Oxford Commercial	$14.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$14.45

RISEDRONATE 30 MG TAB

Facility

$28.90

Hospital Charge Code	60629237
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

RISEDRONATE 5 MG TAB

Facility

$4.15

Hospital Charge Code	60629171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.54
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$2.08

RISEDRONATE 5 MG TAB

Facility

$4.15

Hospital Charge Code	60629171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

RISPERDAL 0.5 MG TAB

Facility

$6.00

Hospital Charge Code	60635317
Hospital Revenue Code	250
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

RISPERDAL 0.5 MG TAB

Facility

$6.00

Hospital Charge Code	60635317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

RISPERDAL CONST

Facility

$287.00

Hospital Charge Code	60635472
Hospital Revenue Code	636
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$69.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

RISPERDAL CONST

Facility

$287.00

Hospital Charge Code	60635472
Hospital Revenue Code	636
Min. Negotiated Rate	$43.05
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	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

RISPERDAL CONSTA

Facility

$1,930.00

Hospital Charge Code	60635566
Hospital Revenue Code	636
Min. Negotiated Rate	$289.50
Max. Negotiated Rate	$965.00
Rate for Payer: Aetna Commercial	$579.00
Rate for Payer: Aetna Medicare Advantage	$579.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.15
Rate for Payer: Cigna Commercial	$965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.06
Rate for Payer: Qualcare PPO/HMO/WC	$289.50

RISPERDAL CONSTA

Facility

$1,930.00

Hospital Charge Code	60635566
Hospital Revenue Code	636
Min. Negotiated Rate	$289.50
Max. Negotiated Rate	$467.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.06
Rate for Payer: Qualcare PPO/HMO/WC	$289.50

RISPERDAL CONSTA 12.5MG

Facility

$671.00

Hospital Charge Code	60635696
Hospital Revenue Code	636
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$162.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.38
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

RISPERDAL CONSTA 12.5MG

Facility

$671.00

Hospital Charge Code	60635696
Hospital Revenue Code	636
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$335.50
Rate for Payer: Aetna Commercial	$201.30
Rate for Payer: Aetna Medicare Advantage	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.10
Rate for Payer: Cigna Commercial	$335.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.38
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

RISPERDAL CONSTA 25/2 ML MG SY

Facility

$2,744.72

Service Code	HCPCS J2794
Hospital Charge Code	606350957
Hospital Revenue Code	636
Min. Negotiated Rate	$411.71
Max. Negotiated Rate	$664.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.22
Rate for Payer: Qualcare PPO/HMO/WC	$411.71

RISPERDAL CONSTA 25/2 ML MG SY

Facility

$2,744.72

Service Code	HCPCS J2794
Hospital Charge Code	606350957
Hospital Revenue Code	636
Min. Negotiated Rate	$411.71
Max. Negotiated Rate	$823.42
Rate for Payer: Aetna Commercial	$823.42
Rate for Payer: Aetna Medicare Advantage	$823.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.22
Rate for Payer: Qualcare PPO/HMO/WC	$411.71

RISPERDAL CONSTA 50 MG

Facility

$5,489.71

Service Code	HCPCS J2794
Hospital Charge Code	60630117
Hospital Revenue Code	636
Min. Negotiated Rate	$823.46
Max. Negotiated Rate	$1,646.91
Rate for Payer: Aetna Commercial	$1,646.91
Rate for Payer: Aetna Medicare Advantage	$1,646.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,399.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,399.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,399.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.51
Rate for Payer: Qualcare PPO/HMO/WC	$823.46

Know your out-of-pocket cost for care.

All Charges