Heights University Hospital

All Charges

Charge

Type

Setting

Price

DEMADEX 5 MG U/D TAB

Facility

$3.00

Hospital Charge Code	60635307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

DEMADEX 5 MG U/D TAB

Facility

$3.00

Hospital Charge Code	60635307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$21.37
Rate for Payer: Aetna Medicare Advantage	$21.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.16
Rate for Payer: Cigna Commercial	$35.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.26
Rate for Payer: Oxford Commercial	$35.61
Rate for Payer: Qualcare PPO/HMO/WC	$10.68
Rate for Payer: UnitedHealthcare Commercial	$35.61

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$10.68
Rate for Payer: Qualcare PPO/HMO/WC	$10.68

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$8.82
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$8.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

DEMEROL 25MGINJ CARPUJECT

Facility

$7.00

Hospital Charge Code	60635304
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

DEMEROL 25MGINJ CARPUJECT

Facility

$7.00

Hospital Charge Code	60635304
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

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$8.82
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$8.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

DEMEROL/75MG/1ML

Facility

$42.00

Hospital Charge Code	60632793
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

DEMEROL/75MG/1ML

Facility

$42.00

Hospital Charge Code	60632793
Hospital Revenue Code	636
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$10.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

DEMEROL BLISTER PACK HOSP

Facility

$4.00

Hospital Charge Code	60632795
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEMEROL BLISTER PACK HOSP

Facility

$4.00

Hospital Charge Code	60632795
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

DEMEROL SYR 50MG/ML P-F

Facility

$122.25

Hospital Charge Code	6008031
Hospital Revenue Code	250
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$36.67
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Oxford Commercial	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$61.12

DEMEROL SYR 50MG/ML P-F

Facility

$122.25

Hospital Charge Code	6008031
Hospital Revenue Code	250
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

DEMINERALISED BONE MATRIX 10cc

Facility

$7,725.00

Hospital Charge Code	270645739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

DEMINERALISED BONE MATRIX 10cc

Facility

$7,725.00

Hospital Charge Code	270645739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,317.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

DEMINERALISED BONE MATRIX 5cc

Facility

$5,050.00

Hospital Charge Code	270645738
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$2,525.00
Rate for Payer: Aetna Commercial	$1,515.00
Rate for Payer: Aetna Medicare Advantage	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.75
Rate for Payer: Cigna Commercial	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

DEMINERALISED BONE MATRIX 5cc

Facility

$5,050.00

Hospital Charge Code	270645738
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$1,222.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.99
Max. Negotiated Rate	$6,879.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99
Rate for Payer: Aetna Commercial	$4,127.98
Rate for Payer: Aetna Medicare Advantage	$4,127.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,508.79
Rate for Payer: Cigna Commercial	$6,879.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.99
Max. Negotiated Rate	$3,329.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99

DEMIREGOTAN/TAB

Facility

$3.00

Hospital Charge Code	60634365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DEMIREGOTAN/TAB

Facility

$3.00

Hospital Charge Code	60634365
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

DEMI-REGROTON

Facility

$3.00

Hospital Charge Code	60634465
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

Know your out-of-pocket cost for care.

All Charges