Heights University Hospital

All Charges

Charge

Type

Setting

Price

D&C DIAG OR THERAP NOT OB

Facility

$16,333.80

Service Code	HCPCS 58120
Hospital Charge Code	16000760
Hospital Revenue Code	360
Min. Negotiated Rate	$2,450.07
Max. Negotiated Rate	$2,450.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07

DCELL155

Facility

$15,525.00

Hospital Charge Code	270657244
Hospital Revenue Code	278
Min. Negotiated Rate	$2,328.75
Max. Negotiated Rate	$3,757.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,757.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,328.75

DCELL155

Facility

$15,525.00

Hospital Charge Code	270657244
Hospital Revenue Code	278
Min. Negotiated Rate	$2,328.75
Max. Negotiated Rate	$7,762.50
Rate for Payer: Aetna Commercial	$4,657.50
Rate for Payer: Aetna Medicare Advantage	$4,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,958.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,958.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,958.88
Rate for Payer: Cigna Commercial	$7,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,757.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,328.75

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna Commercial	$208.69
Rate for Payer: Aetna Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.00
Rate for Payer: Cigna Commercial	$64.41
Rate for Payer: Cigna Medicare Advantage	$32.20
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$224.26
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$68.27
Rate for Payer: Wellcare Medicare Advantage	$64.41

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$224.26
Max. Negotiated Rate	$224.26
Rate for Payer: Qualcare PPO/HMO/WC	$224.26

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$8.22

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$27.41
Rate for Payer: Aetna Commercial	$16.44
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.98
Rate for Payer: Cigna Commercial	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.13
Rate for Payer: Oxford Commercial	$27.41
Rate for Payer: Qualcare PPO/HMO/WC	$8.22
Rate for Payer: UnitedHealthcare Commercial	$27.41

DDAVP NASAL/0.1MG/1ML

Facility

$235.00

Hospital Charge Code	60632779
Hospital Revenue Code	250
Min. Negotiated Rate	$30.55
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$70.50
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$117.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$117.50

DDAVP NASAL/0.1MG/1ML

Facility

$235.00

Hospital Charge Code	60632779
Hospital Revenue Code	250
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

D-DIMER (LATEX)****

Facility

$730.00

Service Code	HCPCS 85378
Hospital Charge Code	3009180
Hospital Revenue Code	305
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

D-DIMER (LATEX)****

Facility

$730.00

Service Code	HCPCS 85378
Hospital Charge Code	3009180
Hospital Revenue Code	305
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.49
Rate for Payer: Aetna Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.61
Rate for Payer: Cigna Commercial	$9.72
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.30
Rate for Payer: Wellcare Medicare Advantage	$9.72

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.98
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.30
Rate for Payer: Cigna Commercial	$10.18
Rate for Payer: Cigna Medicare Advantage	$5.09
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.79
Rate for Payer: Wellcare Medicare Advantage	$10.18

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

D-DIMER QUANTITATIVE

Facility

$44.00

Service Code	HCPCS 85380
Hospital Charge Code	3009185
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

D-DIMER QUANTITATIVE

Facility

$44.00

Service Code	HCPCS 85380
Hospital Charge Code	3009185
Hospital Revenue Code	305
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.98
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.30
Rate for Payer: Cigna Commercial	$10.18
Rate for Payer: Cigna Medicare Advantage	$5.09
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.79
Rate for Payer: Wellcare Medicare Advantage	$10.18

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$103.75
Rate for Payer: Aetna Commercial	$62.25
Rate for Payer: Aetna Medicare Advantage	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.91
Rate for Payer: Cigna Commercial	$103.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.98
Rate for Payer: Oxford Commercial	$103.75
Rate for Payer: Qualcare PPO/HMO/WC	$31.12
Rate for Payer: UnitedHealthcare Commercial	$103.75

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$31.12
Max. Negotiated Rate	$31.12
Rate for Payer: Qualcare PPO/HMO/WC	$31.12

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$1,039.46
Max. Negotiated Rate	$1,039.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$386.54
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Better Health Medicaid	$386.54
Rate for Payer: Aetna Commercial	$2,078.93
Rate for Payer: Aetna Medicare Advantage	$2,078.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.09
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	$1,767.09
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.87
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27
Rate for Payer: Wellpoint Medicaid Managed Care	$386.54

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$388.68
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$896.95
Rate for Payer: Aetna Medicare Advantage	$896.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$762.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$762.40
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	$762.40
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.68
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$448.47
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$448.47
Max. Negotiated Rate	$448.47
Rate for Payer: Qualcare PPO/HMO/WC	$448.47

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$777.45
Max. Negotiated Rate	$777.45
Rate for Payer: Qualcare PPO/HMO/WC	$777.45

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$51.58
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,554.90
Rate for Payer: Aetna Medicare Advantage	$1,554.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.66
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	$1,321.66
Rate for Payer: Cigna Commercial	$51.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$673.79
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$777.45
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.51
Max. Negotiated Rate	$1,191.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$234.39
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Better Health Medicaid	$386.54
Rate for Payer: Aetna Commercial	$2,383.01
Rate for Payer: Aetna Medicare Advantage	$2,383.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,025.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,025.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$234.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,025.56
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,032.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27

Know your out-of-pocket cost for care.

All Charges