Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAPTOPRIL 12.5MG TAB

Facility

$44.70

Hospital Charge Code	6063943072
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$22.35
Rate for Payer: Aetna Commercial	$13.41
Rate for Payer: Aetna Medicare Advantage	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.40
Rate for Payer: Cigna Commercial	$22.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.81
Rate for Payer: Oxford Commercial	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.71
Rate for Payer: UnitedHealthcare Commercial	$22.35

CAPTOPRIL 25 MG TAB

Facility

$7.25

Hospital Charge Code	60627550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

CAPTOPRIL 25 MG TAB

Facility

$7.25

Hospital Charge Code	60627550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

CAPTOPRIL 50 MG TAB

Facility

$11.25

Hospital Charge Code	6009567
Hospital Revenue Code	251
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

CAPTOPRIL 50 MG TAB

Facility

$11.25

Hospital Charge Code	6009567
Hospital Revenue Code	251
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

CAPTOPRIL 50MG TAB

Facility

$42.10

Hospital Charge Code	6063943074
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

CAPTOPRIL 50MG TAB

Facility

$42.10

Hospital Charge Code	6063943074
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$12.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.74
Rate for Payer: Cigna Commercial	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.47
Rate for Payer: Oxford Commercial	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$21.05

CAPTOPRIL TAB 6.25MG/0.5

Facility

$7.70

Hospital Charge Code	60627551
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

CAPTOPRIL TAB 6.25MG/0.5

Facility

$7.70

Hospital Charge Code	60627551
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

CAP TRILOCK HIP 44MM LP

Facility

$4,750.00

Hospital Charge Code	270655467
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAP TRILOCK HIP 44MM LP

Facility

$4,750.00

Hospital Charge Code	270655467
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAP VALVE PLEURAL REPL

Facility

$25.00

Hospital Charge Code	270649134
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

CAP VALVE PLEURAL REPL

Facility

$25.00

Hospital Charge Code	270649134
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

CAP ZIM IM NAIL 2252-03

Facility

$959.25

Hospital Charge Code	270618072
Hospital Revenue Code	272
Min. Negotiated Rate	$124.70
Max. Negotiated Rate	$479.62
Rate for Payer: Aetna Commercial	$287.77
Rate for Payer: Aetna Medicare Advantage	$287.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.61
Rate for Payer: Cigna Commercial	$479.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.70
Rate for Payer: Oxford Commercial	$479.62
Rate for Payer: Qualcare PPO/HMO/WC	$143.89
Rate for Payer: UnitedHealthcare Commercial	$479.62

CAP ZIM IM NAIL 2252-03

Facility

$959.25

Hospital Charge Code	270618072
Hospital Revenue Code	272
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$143.89
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

CARAFATE/1GM/TAB

Facility

$7.00

Hospital Charge Code	60632619
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CARAFATE/1GM/TAB

Facility

$7.00

Hospital Charge Code	60632618
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

CARAFATE/1GM/TAB

Facility

$7.00

Hospital Charge Code	60632618
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CARAFATE/1GM/TAB

Facility

$7.00

Hospital Charge Code	60632619
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

CARAFATE SUSPENSION/GM/10

Facility

$13.00

Hospital Charge Code	60634926
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CARAFATE SUSPENSION/GM/10

Facility

$13.00

Hospital Charge Code	60634926
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

CARBACHOL 0.01% OPHTH SOLN

Facility

$281.65

Hospital Charge Code	60628052
Hospital Revenue Code	250
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

CARBACHOL 0.01% OPHTH SOLN

Facility

$281.65

Hospital Charge Code	60628052
Hospital Revenue Code	250
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

CARBACHOL 0.75% OPHTH SOLN

Facility

$192.85

Hospital Charge Code	60628053
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

CARBACHOL 0.75% OPHTH SOLN

Facility

$192.85

Hospital Charge Code	60628053
Hospital Revenue Code	250
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$96.42
Rate for Payer: Aetna Commercial	$57.85
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$96.42
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$96.42

Know your out-of-pocket cost for care.

All Charges