Heights University Hospital

All Charges

Charge

Type

Setting

Price

CIRCUMCISION

Facility

$160.00

Hospital Charge Code	1800028
Hospital Revenue Code	361
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

CIRCUMCISION BY CLAMP

Facility

$9,810.16

Service Code	HCPCS 54150
Hospital Charge Code	83091010
Hospital Revenue Code	723
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$2,943.05
Rate for Payer: Aetna Medicare Advantage	$2,943.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,501.59
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,275.32
Rate for Payer: Oxford Commercial	$4,905.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52
Rate for Payer: UnitedHealthcare Commercial	$4,905.08

CIRCUMCISION BY CLAMP

Facility

$9,810.16

Service Code	HCPCS 54150
Hospital Charge Code	83091010
Hospital Revenue Code	723
Min. Negotiated Rate	$1,471.52
Max. Negotiated Rate	$1,471.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52

CIRCUMCISION-BY CLAMP

Facility

$9,810.16

Service Code	HCPCS 54150
Hospital Charge Code	83080015
Hospital Revenue Code	361
Min. Negotiated Rate	$1,275.32
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,943.05
Rate for Payer: Aetna Medicare Advantage	$2,943.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,501.59
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,275.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CIRCUMCISION-BY CLAMP

Facility

$9,810.16

Service Code	HCPCS 54150
Hospital Charge Code	83080015
Hospital Revenue Code	361
Min. Negotiated Rate	$1,471.52
Max. Negotiated Rate	$1,471.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52

CIRCUMCISION BY SLIT

Facility

$9,810.16

Service Code	HCPCS 54160
Hospital Charge Code	83091015
Hospital Revenue Code	723
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$4,905.08
Rate for Payer: Aetna Commercial	$2,943.05
Rate for Payer: Aetna Medicare Advantage	$2,943.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,501.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,501.59
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,275.32
Rate for Payer: Oxford Commercial	$4,905.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52
Rate for Payer: UnitedHealthcare Commercial	$4,905.08

CIRCUMCISION BY SLIT

Facility

$9,810.16

Service Code	HCPCS 54160
Hospital Charge Code	83091015
Hospital Revenue Code	723
Min. Negotiated Rate	$1,471.52
Max. Negotiated Rate	$1,471.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52

CIRCUMCISION-BY SLIT

Facility

$10,847.54

Service Code	HCPCS 54160
Hospital Charge Code	83080020
Hospital Revenue Code	723
Min. Negotiated Rate	$1,627.13
Max. Negotiated Rate	$1,627.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.13

CIRCUMCISION-BY SLIT

Facility

$10,847.54

Service Code	HCPCS 54160
Hospital Charge Code	83080020
Hospital Revenue Code	723
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$5,423.77
Rate for Payer: Aetna Commercial	$3,254.26
Rate for Payer: Aetna Medicare Advantage	$3,254.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,766.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,766.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,766.12
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.18
Rate for Payer: Oxford Commercial	$5,423.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.13
Rate for Payer: UnitedHealthcare Commercial	$5,423.77

CIRCUMCISION W CLAMP AND BLOCK

Facility

$9,705.00

Service Code	HCPCS 54150
Hospital Charge Code	87502605
Hospital Revenue Code	361
Min. Negotiated Rate	$1,455.75
Max. Negotiated Rate	$1,455.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.75

CIRCUMCISION W CLAMP AND BLOCK

Facility

$9,705.00

Service Code	HCPCS 54150
Hospital Charge Code	87502605
Hospital Revenue Code	361
Min. Negotiated Rate	$1,261.65
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,911.50
Rate for Payer: Aetna Medicare Advantage	$2,911.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,474.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,474.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,474.78
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.65
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.75
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CIRCUMCISION W/REGIONL BLOCK

Facility

$4,952.46

Service Code	HCPCS 54150
Hospital Charge Code	1600000606
Hospital Revenue Code	360
Min. Negotiated Rate	$643.82
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$1,485.74
Rate for Payer: Aetna Medicare Advantage	$1,485.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.88
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.87
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CIRCUMCISION W/REGIONL BLOCK

Facility

$4,952.46

Service Code	HCPCS 54150
Hospital Charge Code	1600000606
Hospital Revenue Code	360
Min. Negotiated Rate	$742.87
Max. Negotiated Rate	$742.87
Rate for Payer: Qualcare PPO/HMO/WC	$742.87

CIRCUMSICISON-ADULT

Facility

$20,610.70

Service Code	HCPCS 54161
Hospital Charge Code	16000167
Hospital Revenue Code	360
Min. Negotiated Rate	$3,091.61
Max. Negotiated Rate	$3,091.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61

CIRCUMSICISON-ADULT

Facility

$20,610.70

Service Code	HCPCS 54161
Hospital Charge Code	16000167
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,183.21
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Aetna Commercial	$6,183.21
Rate for Payer: Aetna Medicare Advantage	$6,183.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,255.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,255.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,255.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,679.39
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$42,479.22

Service Code	MSDRG 433
Min. Negotiated Rate	$11,525.87
Max. Negotiated Rate	$42,479.22
Rate for Payer: Aetna Commercial	$35,614.94
Rate for Payer: Aetna Medicare Advantage	$11,525.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,394.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,394.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,159.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,394.01
Rate for Payer: Cigna Commercial	$22,730.48
Rate for Payer: Cigna Medicare Advantage	$14,159.74
Rate for Payer: Clover Medicare Advantage	$13,451.75
Rate for Payer: EmblemHealth Commercial	$42,479.22
Rate for Payer: Humana Medicare Advantage	$14,584.53
Rate for Payer: Oxford Commercial	$14,205.89
Rate for Payer: UnitedHealthcare Commercial	$16,125.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,159.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,009.32
Rate for Payer: Wellcare Medicare Advantage	$14,159.74

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$68,950.68

Service Code	MSDRG 432
Min. Negotiated Rate	$21,478.15
Max. Negotiated Rate	$68,950.68
Rate for Payer: Aetna Commercial	$66,367.48
Rate for Payer: Aetna Medicare Advantage	$21,478.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52,928.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52,928.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,983.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52,928.64
Rate for Payer: Cigna Commercial	$42,357.63
Rate for Payer: Cigna Medicare Advantage	$22,983.56
Rate for Payer: Clover Medicare Advantage	$21,834.38
Rate for Payer: EmblemHealth Commercial	$68,950.68
Rate for Payer: Humana Medicare Advantage	$23,673.07
Rate for Payer: Oxford Commercial	$26,472.29
Rate for Payer: UnitedHealthcare Commercial	$30,048.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,983.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24,362.57
Rate for Payer: Wellcare Medicare Advantage	$22,983.56

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$32,503.05

Service Code	MSDRG 434
Min. Negotiated Rate	$7,775.22
Max. Negotiated Rate	$32,503.05
Rate for Payer: Aetna Commercial	$24,025.43
Rate for Payer: Aetna Medicare Advantage	$7,775.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,469.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,469.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,834.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,469.89
Rate for Payer: Cigna Commercial	$15,333.71
Rate for Payer: Cigna Medicare Advantage	$10,834.35
Rate for Payer: Clover Medicare Advantage	$10,292.63
Rate for Payer: EmblemHealth Commercial	$32,503.05
Rate for Payer: Humana Medicare Advantage	$11,159.38
Rate for Payer: Oxford Commercial	$9,583.12
Rate for Payer: UnitedHealthcare Commercial	$10,877.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,834.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,484.41
Rate for Payer: Wellcare Medicare Advantage	$10,834.35

CISAPRIDE SSP 1MG/ML

Facility

$78.10

Hospital Charge Code	60628157
Hospital Revenue Code	250
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$39.05
Rate for Payer: Aetna Commercial	$23.43
Rate for Payer: Aetna Medicare Advantage	$23.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.92
Rate for Payer: Cigna Commercial	$39.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.15
Rate for Payer: Oxford Commercial	$39.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.71
Rate for Payer: UnitedHealthcare Commercial	$39.05

CISAPRIDE SSP 1MG/ML

Facility

$78.10

Hospital Charge Code	60628157
Hospital Revenue Code	250
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$11.71
Rate for Payer: Qualcare PPO/HMO/WC	$11.71

CISAPRIDE TAB 10MG

Facility

$5.80

Hospital Charge Code	6014146
Hospital Revenue Code	252
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

CISAPRIDE TAB 10MG

Facility

$4.50

Hospital Charge Code	60628156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

CISAPRIDE TAB 10MG

Facility

$4.50

Hospital Charge Code	60628156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

CISAPRIDE TAB 10MG

Facility

$5.80

Hospital Charge Code	6014146
Hospital Revenue Code	252
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CISATRACURIUM 10MG/5ML

Facility

$126.03

Service Code	NDC 74437805
Hospital Charge Code	60635765
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

Know your out-of-pocket cost for care.

All Charges