Heights University Hospital

All Charges

Charge

Type

Setting

Price

DECALCIFICATION

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	38474058
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005221
Hospital Revenue Code	310
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$22.05
Rate for Payer: Cigna Medicare Advantage	$11.03
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

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005220
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005220
Hospital Revenue Code	310
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$22.05
Rate for Payer: Cigna Medicare Advantage	$11.03
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

DECALCIFICATION OF BONE

Facility

$390.00

Service Code	HCPCS 88311
Hospital Charge Code	3005221
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DECAL STAT 1212A

Facility

$1,276.85

Hospital Charge Code	270602210
Hospital Revenue Code	272
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

DECAL STAT 1212A

Facility

$1,276.85

Hospital Charge Code	270602210
Hospital Revenue Code	272
Min. Negotiated Rate	$165.99
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$383.06
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.99
Rate for Payer: Oxford Commercial	$638.42
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$638.42

DECASPRAY/25GM

Facility

$75.00

Hospital Charge Code	60634216
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

DECASPRAY/25GM

Facility

$75.00

Hospital Charge Code	60634216
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DECELL PLACENTAL MEMBRANE 5X5C

Facility

$6,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704474
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

DECELL PLACENTAL MEMBRANE 5X5C

Facility

$6,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704474
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

DECITABINE 50MG INJ

Facility

$13,756.44

Service Code	HCPCS J0894
Hospital Charge Code	6063943093
Hospital Revenue Code	636
Min. Negotiated Rate	$2,063.47
Max. Negotiated Rate	$3,329.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.47

DECITABINE 50MG INJ

Facility

$13,756.44

Service Code	HCPCS J0894
Hospital Charge Code	6063943093
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$4,126.93
Rate for Payer: Aetna Commercial	$4,126.93
Rate for Payer: Aetna Medicare Advantage	$4,126.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,507.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,507.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,507.89
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.47

DECITABINE 50 MG REC

Facility

$8,874.00

Hospital Charge Code	60629939
Hospital Revenue Code	636
Min. Negotiated Rate	$1,331.10
Max. Negotiated Rate	$2,147.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.10

DECITABINE 50 MG REC

Facility

$8,874.00

Hospital Charge Code	60629939
Hospital Revenue Code	636
Min. Negotiated Rate	$1,331.10
Max. Negotiated Rate	$4,437.00
Rate for Payer: Aetna Commercial	$2,662.20
Rate for Payer: Aetna Medicare Advantage	$2,662.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,262.87
Rate for Payer: Cigna Commercial	$4,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,147.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,331.10

DECITABINE PER 1 MG INJ 50MG

Facility

$11,862.16

Hospital Charge Code	6063943015
Hospital Revenue Code	636
Min. Negotiated Rate	$1,779.32
Max. Negotiated Rate	$2,870.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,779.32

DECITABINE PER 1 MG INJ 50MG

Facility

$11,862.16

Hospital Charge Code	6063943015
Hospital Revenue Code	636
Min. Negotiated Rate	$1,779.32
Max. Negotiated Rate	$5,931.08
Rate for Payer: Aetna Commercial	$3,558.65
Rate for Payer: Aetna Medicare Advantage	$3,558.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,024.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,024.85
Rate for Payer: Cigna Commercial	$5,931.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,779.32

DECLOMYCIN/150MG/CAP

Facility

$18.00

Hospital Charge Code	60632785
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

DECLOMYCIN/150MG/CAP

Facility

$18.00

Hospital Charge Code	60632785
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DECLOMYCIN/300MG/TAB

Facility

$114.37

Service Code	NDC 65162055548
Hospital Charge Code	60634319
Hospital Revenue Code	250
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$57.19
Rate for Payer: Aetna Commercial	$34.31
Rate for Payer: Aetna Medicare Advantage	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.16
Rate for Payer: Cigna Commercial	$57.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.87
Rate for Payer: Oxford Commercial	$57.19
Rate for Payer: Qualcare PPO/HMO/WC	$17.16
Rate for Payer: UnitedHealthcare Commercial	$57.19

DECLOMYCIN/300MG/TAB

Facility

$114.37

Service Code	NDC 65162055548
Hospital Charge Code	60634319
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$17.16
Rate for Payer: Qualcare PPO/HMO/WC	$17.16

DECLOT VASCULAR DEVICE

Facility

$1,814.20

Service Code	HCPCS 36593
Hospital Charge Code	350036593
Hospital Revenue Code	361
Min. Negotiated Rate	$235.85
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$544.26
Rate for Payer: Aetna Medicare Advantage	$544.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.62
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	$462.62
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$272.13
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	3400080
Hospital Revenue Code	361
Min. Negotiated Rate	$144.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$334.15
Rate for Payer: Aetna Medicare Advantage	$334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.03
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	$284.03
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	3400080
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

DECLOT VASCULAR DEVICE

Facility

$1,814.20

Service Code	HCPCS 36593
Hospital Charge Code	350036593
Hospital Revenue Code	361
Min. Negotiated Rate	$272.13
Max. Negotiated Rate	$272.13
Rate for Payer: Qualcare PPO/HMO/WC	$272.13

Know your out-of-pocket cost for care.

All Charges