Heights University Hospital

All Charges

Charge

Type

Setting

Price

CO2 SMART CAPNOLINE ADULT CO2

Facility

$70.40

Hospital Charge Code	270676818
Hospital Revenue Code	272
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

COAG FACTOR VIII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	39900347
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COAG FACTOR VIII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	39900347
Hospital Revenue Code	305
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.00
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.59
Rate for Payer: Cigna Commercial	$17.90
Rate for Payer: Cigna Medicare Advantage	$8.95
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
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	$17.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.97
Rate for Payer: Wellcare Medicare Advantage	$17.90

COAG/FRIBINOLYSIS FUNCT ACT EA

Facility

$162.50

Service Code	HCPCS 85397
Hospital Charge Code	38477173
Hospital Revenue Code	305
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$99.99
Rate for Payer: Aetna Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.07
Rate for Payer: Cigna Commercial	$30.86
Rate for Payer: Cigna Medicare Advantage	$15.43
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.71
Rate for Payer: Wellcare Medicare Advantage	$30.86

COAG/FRIBINOLYSIS FUNCT ACT EA

Facility

$162.50

Service Code	HCPCS 85397
Hospital Charge Code	38477173
Hospital Revenue Code	305
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

COAG TIME***

Facility

$8.00

Hospital Charge Code	3010832
Hospital Revenue Code	309
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

COAG TIME***

Facility

$8.00

Hospital Charge Code	3010832
Hospital Revenue Code	309
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

COAGULATION AND PLATELET DISORDERS

Facility

$9,702.84

Service Code	APR-DRG 6611
Min. Negotiated Rate	$8,931.17
Max. Negotiated Rate	$9,702.84
Rate for Payer: Aetna Better Health Medicaid	$9,512.59
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,702.84
Rate for Payer: Wellpoint Medicaid Managed Care	$8,931.17

COAGULATION AND PLATELET DISORDERS

Facility

$12,777.09

Service Code	APR-DRG 6612
Min. Negotiated Rate	$10,507.15
Max. Negotiated Rate	$12,777.09
Rate for Payer: Aetna Better Health Medicaid	$12,526.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,777.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10,507.15

COAGULATION AND PLATELET DISORDERS

Facility

$38,168.92

Service Code	APR-DRG 6614
Min. Negotiated Rate	$31,346.62
Max. Negotiated Rate	$38,168.92
Rate for Payer: Aetna Better Health Medicaid	$31,346.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,973.55
Rate for Payer: Wellpoint Medicaid Managed Care	$38,168.92

COAGULATION AND PLATELET DISORDERS

Facility

$20,011.66

Service Code	APR-DRG 6613
Min. Negotiated Rate	$15,938.34
Max. Negotiated Rate	$20,011.66
Rate for Payer: Aetna Better Health Medicaid	$15,938.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,257.11
Rate for Payer: Wellpoint Medicaid Managed Care	$20,011.66

COAGULATION DISORDERS

Facility

$56,095.17

Service Code	MSDRG 813
Min. Negotiated Rate	$16,644.96
Max. Negotiated Rate	$56,095.17
Rate for Payer: Aetna Commercial	$51,432.93
Rate for Payer: Aetna Medicare Advantage	$16,644.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,004.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,004.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,698.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,004.52
Rate for Payer: Cigna Commercial	$32,825.98
Rate for Payer: Cigna Medicare Advantage	$18,698.39
Rate for Payer: Clover Medicare Advantage	$17,763.47
Rate for Payer: EmblemHealth Commercial	$56,095.17
Rate for Payer: Humana Medicare Advantage	$19,259.34
Rate for Payer: Oxford Commercial	$20,515.28
Rate for Payer: UnitedHealthcare Commercial	$23,286.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,698.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19,820.29
Rate for Payer: Wellcare Medicare Advantage	$18,698.39

COAGULATION FACTOR II

Facility

$283.40

Service Code	HCPCS 85210
Hospital Charge Code	3004200
Hospital Revenue Code	305
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.06
Rate for Payer: Aetna Medicare Advantage	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.56
Rate for Payer: Cigna Commercial	$12.98
Rate for Payer: Cigna Medicare Advantage	$6.49
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.76
Rate for Payer: Wellcare Medicare Advantage	$12.98

COAGULATION FACTOR II

Facility

$283.40

Service Code	HCPCS 85210
Hospital Charge Code	3004200
Hospital Revenue Code	305
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

COAGULATION FACTOR IX

Facility

$290.45

Service Code	HCPCS 85250
Hospital Charge Code	3004199
Hospital Revenue Code	305
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.69
Rate for Payer: Aetna Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.76
Rate for Payer: Cigna Commercial	$19.04
Rate for Payer: Cigna Medicare Advantage	$9.52
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.57
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.18
Rate for Payer: Wellcare Medicare Advantage	$19.04

COAGULATION FACTOR IX

Facility

$290.45

Service Code	HCPCS 85250
Hospital Charge Code	3004199
Hospital Revenue Code	305
Min. Negotiated Rate	$43.57
Max. Negotiated Rate	$43.57
Rate for Payer: Qualcare PPO/HMO/WC	$43.57

COAGULATOR SUCT 10F E2506-10

Facility

$110.45

Hospital Charge Code	270600323
Hospital Revenue Code	272
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

COAGULATOR SUCT 10F E2506-10

Facility

$110.45

Hospital Charge Code	270600323
Hospital Revenue Code	272
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$55.23
Rate for Payer: Aetna Commercial	$33.13
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.36
Rate for Payer: Oxford Commercial	$55.23
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$55.23

COALESCE STRAIGHT 10X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270692908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COALESCE STRAIGHT 10X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270692908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$7,260.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COALESCE STRAIGHT 12X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270693048
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$7,260.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COALESCE STRAIGHT 12X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270693048
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COAL TAR 30% TOP SOLN

Facility

$274.45

Hospital Charge Code	60628438
Hospital Revenue Code	250
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$137.22
Rate for Payer: Aetna Commercial	$82.33
Rate for Payer: Aetna Medicare Advantage	$82.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.98
Rate for Payer: Cigna Commercial	$137.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.68
Rate for Payer: Oxford Commercial	$137.22
Rate for Payer: Qualcare PPO/HMO/WC	$41.17
Rate for Payer: UnitedHealthcare Commercial	$137.22

COAL TAR 30% TOP SOLN

Facility

$274.45

Hospital Charge Code	60628438
Hospital Revenue Code	250
Min. Negotiated Rate	$41.17
Max. Negotiated Rate	$41.17
Rate for Payer: Qualcare PPO/HMO/WC	$41.17

COAL TAR SHAMPOO

Facility

$72.85

Hospital Charge Code	60628440
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

Know your out-of-pocket cost for care.

All Charges