Heights University Hospital

All Charges

Charge

Type

Setting

Price

BRETHINE/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632580
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BRETHINE/5MG/TAB

Facility

$44.56

Service Code	NDC 527131101
Hospital Charge Code	60632578
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$22.28
Rate for Payer: Aetna Commercial	$13.37
Rate for Payer: Aetna Medicare Advantage	$13.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.36
Rate for Payer: Cigna Commercial	$22.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.79
Rate for Payer: Oxford Commercial	$22.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.68
Rate for Payer: UnitedHealthcare Commercial	$22.28

BRETYLIUM 50 MG/ML INJ

Facility

$237.65

Hospital Charge Code	60627548
Hospital Revenue Code	250
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$35.65
Rate for Payer: Qualcare PPO/HMO/WC	$35.65

BRETYLIUM 50 MG/ML INJ

Facility

$237.65

Hospital Charge Code	60627548
Hospital Revenue Code	250
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$118.83
Rate for Payer: Aetna Commercial	$71.30
Rate for Payer: Aetna Medicare Advantage	$71.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.60
Rate for Payer: Cigna Commercial	$118.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.89
Rate for Payer: Oxford Commercial	$118.83
Rate for Payer: Qualcare PPO/HMO/WC	$35.65
Rate for Payer: UnitedHealthcare Commercial	$118.83

BRETYLIUM INJ TOSY 50MG/ML

Facility

$213.80

Hospital Charge Code	6000731
Hospital Revenue Code	250
Min. Negotiated Rate	$32.07
Max. Negotiated Rate	$32.07
Rate for Payer: Qualcare PPO/HMO/WC	$32.07

BRETYLIUM INJ TOSY 50MG/ML

Facility

$213.80

Hospital Charge Code	6000731
Hospital Revenue Code	250
Min. Negotiated Rate	$27.79
Max. Negotiated Rate	$106.90
Rate for Payer: Aetna Commercial	$64.14
Rate for Payer: Aetna Medicare Advantage	$64.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.52
Rate for Payer: Cigna Commercial	$106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.79
Rate for Payer: Oxford Commercial	$106.90
Rate for Payer: Qualcare PPO/HMO/WC	$32.07
Rate for Payer: UnitedHealthcare Commercial	$106.90

BRETYLIUM TOSYLATE/1000MG

Facility

$333.00

Hospital Charge Code	60634711
Hospital Revenue Code	250
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

BRETYLIUM TOSYLATE/1000MG

Facility

$333.00

Hospital Charge Code	60634711
Hospital Revenue Code	250
Min. Negotiated Rate	$43.29
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$99.90
Rate for Payer: Aetna Medicare Advantage	$99.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.92
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Oxford Commercial	$166.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Commercial	$166.50

BRETYLIUM TOSYLATE/500MG

Facility

$167.00

Hospital Charge Code	60634712
Hospital Revenue Code	250
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.71
Rate for Payer: Oxford Commercial	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$83.50

BRETYLIUM TOSYLATE/500MG

Facility

$167.00

Hospital Charge Code	60634712
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

BRETYLOL/500MG/10ML

Facility

$155.00

Hospital Charge Code	60632581
Hospital Revenue Code	250
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

BRETYLOL/500MG/10ML

Facility

$155.00

Hospital Charge Code	60632581
Hospital Revenue Code	250
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.15
Rate for Payer: Oxford Commercial	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Commercial	$77.50

BREVIBLOC 2500MG PREMIXED

Facility

$185.00

Hospital Charge Code	60635504
Hospital Revenue Code	250
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

BREVIBLOC 2500MG PREMIXED

Facility

$185.00

Hospital Charge Code	60635504
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

BREVIBLOC 250MG/ML AMP

Facility

$185.00

Hospital Charge Code	60635503
Hospital Revenue Code	250
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

BREVIBLOC 250MG/ML AMP

Facility

$185.00

Hospital Charge Code	60635503
Hospital Revenue Code	250
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

BREVIBLOC AMP 250GM/1ML

Facility

$531.85

Hospital Charge Code	6006605
Hospital Revenue Code	250
Min. Negotiated Rate	$69.14
Max. Negotiated Rate	$265.93
Rate for Payer: Aetna Commercial	$159.56
Rate for Payer: Aetna Medicare Advantage	$159.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.62
Rate for Payer: Cigna Commercial	$265.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.14
Rate for Payer: Oxford Commercial	$265.93
Rate for Payer: Qualcare PPO/HMO/WC	$79.78
Rate for Payer: UnitedHealthcare Commercial	$265.93

BREVIBLOC AMP 250GM/1ML

Facility

$531.85

Hospital Charge Code	6006605
Hospital Revenue Code	250
Min. Negotiated Rate	$79.78
Max. Negotiated Rate	$79.78
Rate for Payer: Qualcare PPO/HMO/WC	$79.78

BREVITAL SODIUM/500MG

Facility

$45.00

Hospital Charge Code	60632582
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

BREVITAL SODIUM/500MG

Facility

$45.00

Hospital Charge Code	60632582
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$5,265.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	270671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$5,191.88
Rate for Payer: Aetna Commercial	$3,115.12
Rate for Payer: Aetna Medicare Advantage	$3,115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.86
Rate for Payer: Cigna Commercial	$5,191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	270671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$2,512.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$5,191.88
Rate for Payer: Aetna Commercial	$3,115.12
Rate for Payer: Aetna Medicare Advantage	$3,115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.86
Rate for Payer: Cigna Commercial	$5,191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

Know your out-of-pocket cost for care.

All Charges