Heights University Hospital

All Charges

Charge

Type

Setting

Price

COCAINE 10%/4ML

Facility

$122.00

Hospital Charge Code	60632722
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$36.60
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$61.00

COCAINE 4% TOP SOLN

Facility

$1,494.70

Service Code	NDC 527172873
Hospital Charge Code	6001333
Hospital Revenue Code	251
Min. Negotiated Rate	$224.21
Max. Negotiated Rate	$224.21
Rate for Payer: Qualcare PPO/HMO/WC	$224.21

COCAINE 4% TOP SOLN

Facility

$1,494.70

Service Code	NDC 527172873
Hospital Charge Code	6001333
Hospital Revenue Code	251
Min. Negotiated Rate	$194.31
Max. Negotiated Rate	$747.35
Rate for Payer: Aetna Commercial	$448.41
Rate for Payer: Aetna Medicare Advantage	$448.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$381.15
Rate for Payer: Cigna Commercial	$747.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.31
Rate for Payer: Oxford Commercial	$747.35
Rate for Payer: Qualcare PPO/HMO/WC	$224.21
Rate for Payer: UnitedHealthcare Commercial	$747.35

COCAINE ABUSE AND DEPENDENCE

Facility

$5,425.12

Service Code	APR-DRG 7742
Min. Negotiated Rate	$3,521.18
Max. Negotiated Rate	$5,425.12
Rate for Payer: Aetna Better Health Medicaid	$5,318.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,425.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3,521.18

COCAINE ABUSE AND DEPENDENCE

Facility

$9,819.46

Service Code	APR-DRG 7743
Min. Negotiated Rate	$6,781.12
Max. Negotiated Rate	$9,819.46
Rate for Payer: Aetna Better Health Medicaid	$9,626.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,819.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6,781.12

COCAINE ABUSE AND DEPENDENCE

Facility

$4,442.09

Service Code	APR-DRG 7741
Min. Negotiated Rate	$3,390.08
Max. Negotiated Rate	$4,442.09
Rate for Payer: Aetna Better Health Medicaid	$4,354.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,442.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3,390.08

COCAINE ABUSE AND DEPENDENCE

Facility

$24,813.70

Service Code	APR-DRG 7744
Min. Negotiated Rate	$23,352.69
Max. Negotiated Rate	$24,813.70
Rate for Payer: Aetna Better Health Medicaid	$23,352.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,819.74
Rate for Payer: Wellpoint Medicaid Managed Care	$24,813.70

COCAINE HCL 10%/4ML

Facility

$122.00

Hospital Charge Code	60634342
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$36.60
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$61.00

COCAINE HCL 10%/4ML

Facility

$122.00

Hospital Charge Code	60634342
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

COCAINE SERUM

Facility

$190.45

Hospital Charge Code	3000765
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

COCAINE SERUM

Facility

$190.45

Hospital Charge Code	3000765
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

COCAINE SOL 4% 4ML

Facility

$142.75

Hospital Charge Code	6001325
Hospital Revenue Code	251
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$42.83
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.56
Rate for Payer: Oxford Commercial	$71.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$71.38

COCAINE SOL 4% 4ML

Facility

$142.75

Hospital Charge Code	6001325
Hospital Revenue Code	251
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

COCAINE,URINE

Facility

$107.00

Service Code	HCPCS 80353
Hospital Charge Code	38472212
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

COCAINE,URINE

Facility

$107.00

Service Code	HCPCS 80353
Hospital Charge Code	38472212
Hospital Revenue Code	301
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.10
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

COCCIDIODES AB IMMUNO

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004116
Hospital Revenue Code	302
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.03
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.16
Rate for Payer: Wellcare Medicare Advantage	$11.47

COCCIDIODES AB IMMUNO

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004116
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIODES AB(TP AG),ID

Facility

$78.85

Service Code	HCPCS 86635
Hospital Charge Code	39900229
Hospital Revenue Code	302
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.83

COCCIDIODES AB(TP AG),ID

Facility

$78.85

Service Code	HCPCS 86635
Hospital Charge Code	39900229
Hospital Revenue Code	302
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.03
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.83
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.16
Rate for Payer: Wellcare Medicare Advantage	$11.47

COCCIDIODES ANTIBODY

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004108
Hospital Revenue Code	302
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.03
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.16
Rate for Payer: Wellcare Medicare Advantage	$11.47

COCCIDIODES ANTIBODY

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3004108
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

COCCIDIOIDES AB,W/RFX TO

Facility

$390.00

Service Code	HCPCS 86635
Hospital Charge Code	39900230
Hospital Revenue Code	302
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.03
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
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	$11.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.16
Rate for Payer: Wellcare Medicare Advantage	$11.47

COCCIDIOIDES AB,W/RFX TO

Facility

$390.00

Service Code	HCPCS 86635
Hospital Charge Code	39900230
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COCCIDIOIDES ANTIBODIES I

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099A
Hospital Revenue Code	302
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.03
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.16
Rate for Payer: Wellcare Medicare Advantage	$11.47

COCCIDIOIDES ANTIBODIES I

Facility

$108.00

Service Code	HCPCS 86635
Hospital Charge Code	3038099A
Hospital Revenue Code	302
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

Know your out-of-pocket cost for care.

All Charges