Heights University Hospital

All Charges

Charge

Type

Setting

Price

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$23.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$23.11

ROFLUMILAST 250MCG TAB

Facility

$46.23

Service Code	NDC 310008828
Hospital Charge Code	606390303
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

ROFLUMILAST 500 MCG TAB

Facility

$46.23

Service Code	NDC 310009530
Hospital Charge Code	60630089
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$23.11
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$23.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$23.11

ROGAINE 2%/180ML

Facility

$830.00

Hospital Charge Code	60633844
Hospital Revenue Code	250
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

ROGAINE 2%/180ML

Facility

$830.00

Hospital Charge Code	60633844
Hospital Revenue Code	250
Min. Negotiated Rate	$107.90
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$249.00
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.90
Rate for Payer: Oxford Commercial	$415.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$415.00

ROGAINE 2%/60ML

Facility

$315.00

Hospital Charge Code	60633843
Hospital Revenue Code	250
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$47.25
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

ROGAINE 2%/60ML

Facility

$315.00

Hospital Charge Code	60633843
Hospital Revenue Code	250
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare Advantage	$94.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.33
Rate for Payer: Cigna Commercial	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.95
Rate for Payer: Oxford Commercial	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$47.25
Rate for Payer: UnitedHealthcare Commercial	$157.50

ROI-C PEEK OPTIMA LT-1 TANTALU

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$3,499.50
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

ROI-C PEEK OPTIMA LT-1 TANTALU

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

ROMI II

Facility

$48.00

Hospital Charge Code	3052438
Hospital Revenue Code	309
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

ROMI II

Facility

$48.00

Hospital Charge Code	3052438
Hospital Revenue Code	309
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

ROMI I-LD

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	3032120
Hospital Revenue Code	301
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.40
Rate for Payer: Aetna Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.69
Rate for Payer: Cigna Commercial	$12.47
Rate for Payer: Cigna Medicare Advantage	$6.24
Rate for Payer: Clover Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$37.41
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.22
Rate for Payer: Wellcare Medicare Advantage	$12.47

ROMI I-LD

Facility

$123.44

Service Code	HCPCS 84484
Hospital Charge Code	3032120
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

ROMI LD IS***

Facility

$64.00

Service Code	HCPCS 83520
Hospital Charge Code	3032463
Hospital Revenue Code	309
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

ROMI LD IS***

Facility

$64.00

Service Code	HCPCS 83520
Hospital Charge Code	3032463
Hospital Revenue Code	309
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

ROMIPLOSTIM 10MCG VIAL

Facility

$11,258.81

Service Code	HCPCS J2796
Hospital Charge Code	60630031
Hospital Revenue Code	636
Min. Negotiated Rate	$1,688.82
Max. Negotiated Rate	$5,629.40
Rate for Payer: Aetna Commercial	$3,377.64
Rate for Payer: Aetna Medicare Advantage	$3,377.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,871.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,871.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,871.00
Rate for Payer: Cigna Commercial	$5,629.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.82

ROMIPLOSTIM 10MCG VIAL

Facility

$11,258.81

Service Code	HCPCS J2796
Hospital Charge Code	60630031
Hospital Revenue Code	636
Min. Negotiated Rate	$1,688.82
Max. Negotiated Rate	$2,724.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.82

RONDEC/30ML

Facility

$89.00

Hospital Charge Code	60633846
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

RONDEC/30ML

Facility

$89.00

Hospital Charge Code	60633846
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

RONDEC/480ML

Facility

$110.00

Hospital Charge Code	60633845
Hospital Revenue Code	250
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

RONDEC/480ML

Facility

$110.00

Hospital Charge Code	60633845
Hospital Revenue Code	250
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

RONDEC-DM/120ML

Facility

$13.00

Hospital Charge Code	60633847
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

RONDEC-DM/120ML

Facility

$13.00

Hospital Charge Code	60633847
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

RONDEC DM 30ML

Facility

$4.00

Hospital Charge Code	60635482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges