Heights University Hospital

All Charges

Charge

Type

Setting

Price

RISPERIDONE CONSTA 12.5MG/2ML

Facility

$1,372.50

Service Code	HCPCS J2794
Hospital Charge Code	606390334
Hospital Revenue Code	636
Min. Negotiated Rate	$205.88
Max. Negotiated Rate	$411.75
Rate for Payer: Aetna Commercial	$411.75
Rate for Payer: Aetna Medicare Advantage	$411.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.14
Rate for Payer: Qualcare PPO/HMO/WC	$205.88

RISPERIDONE CONSTA 12.5MG/2ML

Facility

$1,372.50

Service Code	HCPCS J2794
Hospital Charge Code	606390334
Hospital Revenue Code	636
Min. Negotiated Rate	$205.88
Max. Negotiated Rate	$332.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.14
Rate for Payer: Qualcare PPO/HMO/WC	$205.88

RISPERIDONE CONSTA 12.5MG INJ

Facility

$5,259.90

Hospital Charge Code	6063943174
Hospital Revenue Code	636
Min. Negotiated Rate	$788.99
Max. Negotiated Rate	$1,272.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.90
Rate for Payer: Qualcare PPO/HMO/WC	$788.99

RISPERIDONE CONSTA 12.5MG INJ

Facility

$5,259.90

Hospital Charge Code	6063943174
Hospital Revenue Code	636
Min. Negotiated Rate	$788.99
Max. Negotiated Rate	$2,629.95
Rate for Payer: Aetna Commercial	$1,577.97
Rate for Payer: Aetna Medicare Advantage	$1,577.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,341.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,341.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,341.27
Rate for Payer: Cigna Commercial	$2,629.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.90
Rate for Payer: Qualcare PPO/HMO/WC	$788.99

RISPERIDONE CONSTA 37.5MG/2 ML

Facility

$4,117.22

Service Code	HCPCS J2794
Hospital Charge Code	60630030
Hospital Revenue Code	636
Min. Negotiated Rate	$617.58
Max. Negotiated Rate	$1,235.17
Rate for Payer: Aetna Commercial	$1,235.17
Rate for Payer: Aetna Medicare Advantage	$1,235.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,049.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,049.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,049.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$996.37
Rate for Payer: Qualcare PPO/HMO/WC	$617.58

RISPERIDONE CONSTA 37.5MG/2 ML

Facility

$4,117.22

Service Code	HCPCS J2794
Hospital Charge Code	60630030
Hospital Revenue Code	636
Min. Negotiated Rate	$617.58
Max. Negotiated Rate	$996.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$996.37
Rate for Payer: Qualcare PPO/HMO/WC	$617.58

RISPERIDONE TAB 3MG

Facility

$28.80

Hospital Charge Code	6020003
Hospital Revenue Code	252
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

RISPERIDONE TAB 3MG

Facility

$28.80

Hospital Charge Code	6020003
Hospital Revenue Code	252
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$8.64
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$14.40

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38473005
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38479464
Hospital Revenue Code	305
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38473005
Hospital Revenue Code	305
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38479464
Hospital Revenue Code	305
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$74.33
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.05
Rate for Payer: Cigna Commercial	$22.94
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.32
Rate for Payer: Wellcare Medicare Advantage	$22.94

RISTOCETIN COFACTOR***

Facility

$27.00

Hospital Charge Code	3032539
Hospital Revenue Code	309
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

RISTOCETIN COFACTOR***

Facility

$27.00

Hospital Charge Code	3032539
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

RITALIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60635879
Hospital Revenue Code	259
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

RITALIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60635879
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

RITODRINE HCL INJ 10MG/ML 5ML

Facility

$665.00

Hospital Charge Code	6004816
Hospital Revenue Code	250
Min. Negotiated Rate	$86.45
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.45
Rate for Payer: Oxford Commercial	$332.50
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Commercial	$332.50

RITODRINE HCL INJ 10MG/ML 5ML

Facility

$665.00

Hospital Charge Code	6004816
Hospital Revenue Code	250
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$99.75
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

RITODRINE INJ 10MG/1ML 5ML

Facility

$790.40

Hospital Charge Code	60627468
Hospital Revenue Code	250
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$395.20
Rate for Payer: Aetna Commercial	$237.12
Rate for Payer: Aetna Medicare Advantage	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.55
Rate for Payer: Cigna Commercial	$395.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.75
Rate for Payer: Oxford Commercial	$395.20
Rate for Payer: Qualcare PPO/HMO/WC	$118.56
Rate for Payer: UnitedHealthcare Commercial	$395.20

RITODRINE INJ 10MG/1ML 5ML

Facility

$790.40

Hospital Charge Code	60627468
Hospital Revenue Code	250
Min. Negotiated Rate	$118.56
Max. Negotiated Rate	$118.56
Rate for Payer: Qualcare PPO/HMO/WC	$118.56

RITODRINE INJ/10MG/ML

Facility

$222.00

Hospital Charge Code	60634270
Hospital Revenue Code	250
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$66.60
Rate for Payer: Aetna Medicare Advantage	$66.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.61
Rate for Payer: Cigna Commercial	$111.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.86
Rate for Payer: Oxford Commercial	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.30
Rate for Payer: UnitedHealthcare Commercial	$111.00

RITODRINE INJ/10MG/ML

Facility

$222.00

Hospital Charge Code	60634270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.30

RITONAVIR 100 MG TAB

Facility

$68.94

Service Code	NDC 74234030
Hospital Charge Code	606350993
Hospital Revenue Code	250
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$34.47
Rate for Payer: Aetna Commercial	$20.68
Rate for Payer: Aetna Medicare Advantage	$20.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.58
Rate for Payer: Cigna Commercial	$34.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.96
Rate for Payer: Oxford Commercial	$34.47
Rate for Payer: Qualcare PPO/HMO/WC	$10.34
Rate for Payer: UnitedHealthcare Commercial	$34.47

RITONAVIR 100 MG TAB

Facility

$68.94

Service Code	NDC 74234030
Hospital Charge Code	606350993
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$10.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.34

RITUXAN 500MG/50ML

Facility

$8,195.00

Hospital Charge Code	60635231
Hospital Revenue Code	636
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$1,983.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

Know your out-of-pocket cost for care.

All Charges