Horizon Blue Cross of NJ-Exchange: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Horizon Blue Cross of NJ-Exchange appears in disclosed negotiated rates across 1 hospital and 69 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

69 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
ALTEPLASE (TPA) 1 MG/ML SYRINGE EVD CLEARANCE Outpatient	Penn Medicine Princeton Health	J2997 HCPCS	$255	$255	$23.51 – $255	—
ALTEPLASE (TPA) INJECTION 1MG/ML ORD Outpatient	Penn Medicine Princeton Health	J2997 HCPCS	$308	$308	$28.40 – $308	—
ALTEPLASE (TPA) INJECTION 5MG/5ML ORD Outpatient	Penn Medicine Princeton Health	J2997 HCPCS	$1,372	$1,372	$88.82 – $1,372	—
AMPHOTERICIN B 100 MCG/ML NASAL IRRIGATION ORD Outpatient	Penn Medicine Princeton Health	J0285 HCPCS	$28.00	$28.00	$2.58 – $50.07	—
AMPICILLIN IVPB 1G/50ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J0290 HCPCS	$31.00	$31.00	$0.59 – $31.00	—
AMPICILLIN IVPB 2G/100ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J0290 HCPCS	$56.00	$56.00	$0.59 – $56.00	—
ATROPINE SULFATE 0.4 MG/ML INJECTION SOLN (WRAPPER Outpatient	Penn Medicine Princeton Health	J0461 HCPCS	$32.00	$32.00	$0.07 – $32.00	—
BETAMETHASONE SOD PHOS ACET 6 (33) MG/ML INJECTI Outpatient	Penn Medicine Princeton Health	J0702 HCPCS	$48.00	$48.00	$4.43 – $48.00	—
CEFAZOLIN 100 MG/ML (ANESTHESIA) Outpatient	Penn Medicine Princeton Health	J0690 HCPCS	$2.00	$2.00	$0.18 – $2.00	—
CEFAZOLIN FORTE 50 MG/ML OPHTH SOLN ORD Outpatient	Penn Medicine Princeton Health	J0690 HCPCS	$89.00	$89.00	$0.81 – $89.00	—
CEFAZOLIN SODIUM 1 G INJECTION SOLR Outpatient	Penn Medicine Princeton Health	J0690 HCPCS	$23.00	$23.00	$0.81 – $23.00	—
CEFTAZIDIME 50 MG/ML OPHTH SOLN ORD Outpatient	Penn Medicine Princeton Health	J0713 HCPCS	$183	$183	$1.47 – $183	—
CIDOFOVIR 15 MG/ML IV SOLN Outpatient	Penn Medicine Princeton Health	J0740 HCPCS	$533	$533	$49.14 – $533	—
DEXAMETHASONE 0.25 MG PO SPLIT TABLET Outpatient	Penn Medicine Princeton Health	J8540 HCPCS	$1.00	$1.00	$0.01 – $1.00	—
DEXAMETHASONE IVPB 10MG/50ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J1100 HCPCS	$23.00	$23.00	$0.11 – $23.00	—
DEXAMETHASONE IVPB 12MG/50ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J1100 HCPCS	$24.00	$24.00	$0.11 – $24.00	—
DEXAMETHASONE IVPB 20MG/50ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J1100 HCPCS	$28.00	$28.00	$0.11 – $28.00	—
DEXAMETHASONE IVPB 8MG/50ML NSS (CNR) Outpatient	Penn Medicine Princeton Health	J1100 HCPCS	$22.00	$22.00	$0.11 – $22.00	—
EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML INJECTION SOLN Outpatient	Penn Medicine Princeton Health	J0171 HCPCS	$450	$450	$0.76 – $450	—
EPOPROSTENOL (FLOLAN) 1.5 MG IN 50 ML INHALATION S Outpatient	Penn Medicine Princeton Health	J1325 HCPCS	$170	$170	$15.65 – $170	—
FENTANYL 250 MCG/25 ML SYRINGE INJECTION SOLN ORD Outpatient	Penn Medicine Princeton Health	J3010 HCPCS	$27.00	$27.00	$0.85 – $27.00	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN EPIDURA Outpatient	Penn Medicine Princeton Health	J3010 HCPCS	$1.00	$1.00	$0.09 – $1.19	—
FENTANYL CITRATE 0.05 MG/ML INJECTION SOLN INTRATH Outpatient	Penn Medicine Princeton Health	J3010 HCPCS	$1.00	$1.00	$0.09 – $1.19	—
FENTANYL PCA 1500 MCG/30ML (CNR) (WRAPPER) Outpatient	Penn Medicine Princeton Health	J3010 HCPCS	$10.00	$10.00	$0.85 – $10.00	—
FENTANYL PCA 250 MCG/25ML (CNR) Outpatient	Penn Medicine Princeton Health	J3010 HCPCS	$1,080	$1,080	$0.85 – $1,080	—