Heights University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN E

Facility

$236.00

Service Code	HCPCS 84446
Hospital Charge Code	38472701
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

VITAMIN E

Facility

$390.00

Service Code	HCPCS 84446
Hospital Charge Code	39900143
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

VITAMIN E

Facility

$236.00

Service Code	HCPCS 84446
Hospital Charge Code	38472701
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

VITAMIN E 100 IU SGL

Facility

$4.00

Service Code	NDC 904027060
Hospital Charge Code	6063943261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

VITAMIN E 100 IU SGL

Facility

$4.00

Service Code	NDC 904027060
Hospital Charge Code	6063943261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN E 100 UNITS CAP

Facility

$2.45

Hospital Charge Code	60628723
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

VITAMIN E 100 UNITS CAP

Facility

$2.45

Hospital Charge Code	60628723
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

VITAMIN E/400U/CAP

Facility

$1.00

Hospital Charge Code	60634307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

VITAMIN E/400U/CAP

Facility

$1.00

Hospital Charge Code	60634307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN E (A-TOCOPHEROL)

Facility

$175.25

Service Code	HCPCS 84446
Hospital Charge Code	3002789
Hospital Revenue Code	301
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$26.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.29

VITAMIN E (A-TOCOPHEROL)

Facility

$175.25

Service Code	HCPCS 84446
Hospital Charge Code	3002789
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.29
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

VITAMIN E LQ 50IU/ML 60ML

Facility

$113.30

Hospital Charge Code	6005698
Hospital Revenue Code	251
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

VITAMIN E LQ 50IU/ML 60ML

Facility

$113.30

Hospital Charge Code	6005698
Hospital Revenue Code	251
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$33.99
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$56.65
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$56.65

VITAMIN K

Facility

$97.10

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$14.56
Rate for Payer: Qualcare PPO/HMO/WC	$14.56

VITAMIN K

Facility

$638.45

Service Code	HCPCS 84597
Hospital Charge Code	3032372
Hospital Revenue Code	301
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

VITAMIN K

Facility

$97.10

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.45
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.27
Rate for Payer: Cigna Commercial	$13.72
Rate for Payer: Cigna Medicare Advantage	$6.86
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.54
Rate for Payer: Wellcare Medicare Advantage	$13.72

VITAMIN K

Facility

$638.45

Service Code	HCPCS 84597
Hospital Charge Code	3032372
Hospital Revenue Code	301
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.45
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.27
Rate for Payer: Cigna Commercial	$13.72
Rate for Payer: Cigna Medicare Advantage	$6.86
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.54
Rate for Payer: Wellcare Medicare Advantage	$13.72

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.45
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.27
Rate for Payer: Cigna Commercial	$13.72
Rate for Payer: Cigna Medicare Advantage	$6.86
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.54
Rate for Payer: Wellcare Medicare Advantage	$13.72

VITAMIN K 10MG/VIAL

Facility

$37.80

Hospital Charge Code	6010193
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

VITAMIN K 10MG/VIAL

Facility

$37.80

Hospital Charge Code	6010193
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

VITAMIN MULTI INJ VL 50ML

Facility

$53.80

Hospital Charge Code	6009138
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

VITAMIN MULTI INJ VL 50ML

Facility

$53.80

Hospital Charge Code	6009138
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

Know your out-of-pocket cost for care.

All Charges