Heights University Hospital

All Charges

Charge

Type

Setting

Price

RITUXAN 500MG/50ML

Facility

$8,195.00

Hospital Charge Code	60635231
Hospital Revenue Code	636
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$4,097.50
Rate for Payer: Aetna Commercial	$2,458.50
Rate for Payer: Aetna Medicare Advantage	$2,458.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,089.72
Rate for Payer: Cigna Commercial	$4,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

RITUXAN SENSITIVITY (CD20

Facility

$184.00

Service Code	HCPCS 86356
Hospital Charge Code	39900220
Hospital Revenue Code	302
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

RITUXAN SENSITIVITY (CD20

Facility

$184.00

Service Code	HCPCS 86356
Hospital Charge Code	39900220
Hospital Revenue Code	302
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.77
Rate for Payer: Aetna Medicare Advantage	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.12
Rate for Payer: Cigna Commercial	$26.78
Rate for Payer: Cigna Medicare Advantage	$13.39
Rate for Payer: Clover Medicare Advantage	$25.44
Rate for Payer: EmblemHealth Commercial	$80.34
Rate for Payer: Humana Medicare Advantage	$27.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.39
Rate for Payer: Wellcare Medicare Advantage	$26.78

RITUXIMAB 100MG/10 ML INJ.

Facility

$5,186.27

Service Code	HCPCS J9312
Hospital Charge Code	60628699
Hospital Revenue Code	636
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,255.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.08
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

RITUXIMAB 100MG/10 ML INJ.

Facility

$5,186.27

Service Code	HCPCS J9312
Hospital Charge Code	60628699
Hospital Revenue Code	636
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,555.88
Rate for Payer: Aetna Commercial	$1,555.88
Rate for Payer: Aetna Medicare Advantage	$1,555.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.08
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

RITUXIMAB 500 MG/50 ML INJ.

Facility

$320.50

Hospital Charge Code	60628700
Hospital Revenue Code	636
Min. Negotiated Rate	$48.08
Max. Negotiated Rate	$160.25
Rate for Payer: Aetna Commercial	$96.15
Rate for Payer: Aetna Medicare Advantage	$96.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.73
Rate for Payer: Cigna Commercial	$160.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.08

RITUXIMAB 500 MG/50 ML INJ.

Facility

$320.50

Hospital Charge Code	60628700
Hospital Revenue Code	636
Min. Negotiated Rate	$48.08
Max. Negotiated Rate	$77.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.08

RITUXIMAB-ABBS 100MG/10ML

Facility

$679.85

Service Code	HCPCS Q5115
Hospital Charge Code	606390348
Hospital Revenue Code	636
Min. Negotiated Rate	$101.98
Max. Negotiated Rate	$164.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.52
Rate for Payer: Qualcare PPO/HMO/WC	$101.98

RITUXIMAB-ABBS 100MG/10ML

Facility

$679.85

Service Code	HCPCS Q5115
Hospital Charge Code	606390348
Hospital Revenue Code	636
Min. Negotiated Rate	$101.98
Max. Negotiated Rate	$203.96
Rate for Payer: Aetna Commercial	$203.96
Rate for Payer: Aetna Medicare Advantage	$203.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.52
Rate for Payer: Qualcare PPO/HMO/WC	$101.98

RITUXIMAB PVVR 10MG/ML

Facility

$3,015.00

Service Code	HCPCS Q5119
Hospital Charge Code	6064943021
Hospital Revenue Code	636
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

RITUXIMAB PVVR 10MG/ML

Facility

$3,015.00

Service Code	HCPCS Q5119
Hospital Charge Code	6064943021
Hospital Revenue Code	636
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna Commercial	$904.50
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

RIV4 VACC RECOMBINANT DNA IM

Facility

$222.65

Service Code	HCPCS 90682
Hospital Charge Code	412390682
Hospital Revenue Code	636
Min. Negotiated Rate	$33.40
Max. Negotiated Rate	$111.33
Rate for Payer: Aetna Commercial	$66.80
Rate for Payer: Aetna Medicare Advantage	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.78
Rate for Payer: Cigna Commercial	$111.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$33.40

RIV4 VACC RECOMBINANT DNA IM

Facility

$222.65

Service Code	HCPCS 90682
Hospital Charge Code	412390682
Hospital Revenue Code	636
Min. Negotiated Rate	$33.40
Max. Negotiated Rate	$53.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$33.40

RIVAL NUCLEAR PROTEIN***

Facility

$259.00

Service Code	HCPCS 86235
Hospital Charge Code	3032406
Hospital Revenue Code	309
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

RIVAL NUCLEAR PROTEIN***

Facility

$259.00

Service Code	HCPCS 86235
Hospital Charge Code	3032406
Hospital Revenue Code	309
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

RIVAROXABAN 15MG TAB

Facility

$53.05

Hospital Charge Code	60635910
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.96

RIVAROXABAN 15MG TAB

Facility

$53.05

Hospital Charge Code	60635910
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$26.52
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare Advantage	$15.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.53
Rate for Payer: Cigna Commercial	$26.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$26.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.96
Rate for Payer: UnitedHealthcare Commercial	$26.52

RIVAROXABAN 2.5MG TAB

Facility

$35.58

Service Code	NDC 50458057710
Hospital Charge Code	606390289
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

RIVAROXABAN 2.5MG TAB

Facility

$35.58

Service Code	NDC 50458057710
Hospital Charge Code	606390289
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$10.67
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.07
Rate for Payer: Cigna Commercial	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$17.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$17.79

RIVASTIGMINE 1.5 MG CAP

Facility

$28.41

Service Code	NDC 781261460
Hospital Charge Code	60629076
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$4.26
Rate for Payer: Qualcare PPO/HMO/WC	$4.26

RIVASTIGMINE 1.5 MG CAP

Facility

$28.41

Service Code	NDC 781261460
Hospital Charge Code	60629076
Hospital Revenue Code	250
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$14.21
Rate for Payer: Aetna Commercial	$8.52
Rate for Payer: Aetna Medicare Advantage	$8.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.24
Rate for Payer: Cigna Commercial	$14.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.69
Rate for Payer: Oxford Commercial	$14.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.26
Rate for Payer: UnitedHealthcare Commercial	$14.21

RIVASTIGMINE 3 MG CAP

Facility

$28.41

Service Code	NDC 781261560
Hospital Charge Code	60629182
Hospital Revenue Code	250
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$14.21
Rate for Payer: Aetna Commercial	$8.52
Rate for Payer: Aetna Medicare Advantage	$8.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.24
Rate for Payer: Cigna Commercial	$14.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.69
Rate for Payer: Oxford Commercial	$14.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.26
Rate for Payer: UnitedHealthcare Commercial	$14.21

RIVASTIGMINE 3 MG CAP

Facility

$28.41

Service Code	NDC 781261560
Hospital Charge Code	60629182
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$4.26
Rate for Payer: Qualcare PPO/HMO/WC	$4.26

RIVASTIGMINE 4.6 MG PATCH

Facility

$100.70

Service Code	NDC 78050115
Hospital Charge Code	60630006
Hospital Revenue Code	250
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$30.21
Rate for Payer: Aetna Medicare Advantage	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.68
Rate for Payer: Cigna Commercial	$50.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.09
Rate for Payer: Oxford Commercial	$50.35
Rate for Payer: Qualcare PPO/HMO/WC	$15.11
Rate for Payer: UnitedHealthcare Commercial	$50.35

RIVASTIGMINE 4.6 MG PATCH

Facility

$100.70

Service Code	NDC 78050115
Hospital Charge Code	60630006
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$15.11

Know your out-of-pocket cost for care.

All Charges