Heights University Hospital

All Charges

Charge

Type

Setting

Price

CWS 400 KIT DRAIN 3/16

Facility

$207.00

Hospital Charge Code	270331370
Hospital Revenue Code	272
Min. Negotiated Rate	$26.91
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$62.10
Rate for Payer: Aetna Medicare Advantage	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.91
Rate for Payer: Oxford Commercial	$103.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$103.50

CX PRECONNECT MS 21 CM PS OTL

Facility

$70,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270703662
Hospital Revenue Code	278
Min. Negotiated Rate	$10,548.75
Max. Negotiated Rate	$17,018.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,018.65
Rate for Payer: Qualcare PPO/HMO/WC	$10,548.75

CX PRECONNECT MS 21 CM PS OTL

Facility

$70,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270703662
Hospital Revenue Code	278
Min. Negotiated Rate	$10,548.75
Max. Negotiated Rate	$35,162.50
Rate for Payer: Aetna Medicare Advantage	$21,097.50
Rate for Payer: Aetna Commercial	$21,097.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,932.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,932.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,065.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,932.88
Rate for Payer: Cigna Commercial	$35,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,018.65
Rate for Payer: Qualcare PPO/HMO/WC	$10,548.75

CYANIDE

Facility

$301.00

Service Code	HCPCS 82600
Hospital Charge Code	38473105
Hospital Revenue Code	301
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Qualcare PPO/HMO/WC	$45.15

CYANIDE

Facility

$301.00

Service Code	HCPCS 82600
Hospital Charge Code	38473105
Hospital Revenue Code	301
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.86
Rate for Payer: Aetna Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.08
Rate for Payer: Cigna Commercial	$19.40
Rate for Payer: Cigna Medicare Advantage	$9.70
Rate for Payer: Clover Medicare Advantage	$18.43
Rate for Payer: EmblemHealth Commercial	$58.20
Rate for Payer: Humana Medicare Advantage	$19.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.56
Rate for Payer: Wellcare Medicare Advantage	$19.40

CYANIDE ANTIDOTE KIT

Facility

$1,226.25

Hospital Charge Code	60628598
Hospital Revenue Code	250
Min. Negotiated Rate	$183.94
Max. Negotiated Rate	$183.94
Rate for Payer: Qualcare PPO/HMO/WC	$183.94

CYANIDE ANTIDOTE KIT

Facility

$3,079.86

Service Code	NDC 11098050701
Hospital Charge Code	60628548
Hospital Revenue Code	250
Min. Negotiated Rate	$461.98
Max. Negotiated Rate	$461.98
Rate for Payer: Qualcare PPO/HMO/WC	$461.98

CYANIDE ANTIDOTE KIT

Facility

$3,079.86

Service Code	NDC 11098050701
Hospital Charge Code	60628548
Hospital Revenue Code	250
Min. Negotiated Rate	$400.38
Max. Negotiated Rate	$1,539.93
Rate for Payer: Aetna Commercial	$923.96
Rate for Payer: Aetna Medicare Advantage	$923.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$785.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$785.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$785.36
Rate for Payer: Cigna Commercial	$1,539.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.38
Rate for Payer: Oxford Commercial	$1,539.93
Rate for Payer: Qualcare PPO/HMO/WC	$461.98
Rate for Payer: UnitedHealthcare Commercial	$1,539.93

CYANIDE ANTIDOTE KIT

Facility

$1,226.25

Hospital Charge Code	60628598
Hospital Revenue Code	250
Min. Negotiated Rate	$159.41
Max. Negotiated Rate	$613.12
Rate for Payer: Aetna Commercial	$367.88
Rate for Payer: Aetna Medicare Advantage	$367.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.69
Rate for Payer: Cigna Commercial	$613.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.41
Rate for Payer: Oxford Commercial	$613.12
Rate for Payer: Qualcare PPO/HMO/WC	$183.94
Rate for Payer: UnitedHealthcare Commercial	$613.12

CYANIDE, BLOOD

Facility

$133.30

Service Code	HCPCS 82600
Hospital Charge Code	3038098
Hospital Revenue Code	300
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

CYANIDE, BLOOD

Facility

$133.30

Service Code	HCPCS 82600
Hospital Charge Code	3038098
Hospital Revenue Code	300
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.86
Rate for Payer: Aetna Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.08
Rate for Payer: Cigna Commercial	$19.40
Rate for Payer: Cigna Medicare Advantage	$9.70
Rate for Payer: Clover Medicare Advantage	$18.43
Rate for Payer: EmblemHealth Commercial	$58.20
Rate for Payer: Humana Medicare Advantage	$19.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.56
Rate for Payer: Wellcare Medicare Advantage	$19.40

CYANIDE KIT

Facility

$1,114.90

Hospital Charge Code	6006233
Hospital Revenue Code	250
Min. Negotiated Rate	$144.94
Max. Negotiated Rate	$557.45
Rate for Payer: Aetna Commercial	$334.47
Rate for Payer: Aetna Medicare Advantage	$334.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.30
Rate for Payer: Cigna Commercial	$557.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.94
Rate for Payer: Oxford Commercial	$557.45
Rate for Payer: Qualcare PPO/HMO/WC	$167.24
Rate for Payer: UnitedHealthcare Commercial	$557.45

CYANIDE KIT

Facility

$1,114.90

Hospital Charge Code	6006233
Hospital Revenue Code	250
Min. Negotiated Rate	$167.24
Max. Negotiated Rate	$167.24
Rate for Payer: Qualcare PPO/HMO/WC	$167.24

CYANOCOBALAMIN/1000MCG/IN

Facility

$65.00

Hospital Charge Code	60632760
Hospital Revenue Code	636
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$15.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CYANOCOBALAMIN/1000MCG/IN

Facility

$65.00

Hospital Charge Code	60632760
Hospital Revenue Code	636
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CYANOCOBALAMIN 1,000MCG/ML

Facility

$7.00

Hospital Charge Code	83652559
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
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	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CYANOCOBALAMIN 1,000MCG/ML

Facility

$7.00

Hospital Charge Code	83652559
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CYANOCOBALAMIN 1000 MCG/ML INJ

Facility

$58.56

Service Code	HCPCS J3420
Hospital Charge Code	60628481
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$17.57
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$17.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.93
Rate for Payer: Cigna Commercial	$0.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.78

CYANOCOBALAMIN 1000 MCG/ML INJ

Facility

$58.56

Service Code	HCPCS J3420
Hospital Charge Code	60628481
Hospital Revenue Code	636
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$14.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.78

CYANOCOBALAMIN 1000MCG/TA

Facility

$1.00

Hospital Charge Code	60635531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CYANOCOBALAMIN 1000MCG/TA

Facility

$1.00

Hospital Charge Code	60635531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

CYANOCOBALAMIN 1000 MCG TAB

Facility

$4.00

Service Code	NDC 536355601
Hospital Charge Code	60630068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 1000 MCG TAB

Facility

$4.00

Service Code	NDC 536355601
Hospital Charge Code	60630068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CYANOCOBALAMIN 100 MCG TAB

Facility

$4.00

Service Code	NDC 904113213
Hospital Charge Code	60629046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CYANOCOBALAMIN 100 MCG TAB

Facility

$4.00

Service Code	NDC 904113213
Hospital Charge Code	60629046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges