Heights University Hospital

All Charges

Charge

Type

Setting

Price

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$32,386.95

Service Code	MSDRG 159
Min. Negotiated Rate	$7,731.56
Max. Negotiated Rate	$32,386.95
Rate for Payer: Cigna Medicare Advantage	$10,795.65
Rate for Payer: Aetna Commercial	$23,890.52
Rate for Payer: Aetna Medicare Advantage	$7,731.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,745.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,745.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,795.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,745.56
Rate for Payer: Cigna Commercial	$15,247.63
Rate for Payer: Clover Medicare Advantage	$10,255.87
Rate for Payer: EmblemHealth Commercial	$32,386.95
Rate for Payer: Humana Medicare Advantage	$11,119.52
Rate for Payer: Oxford Commercial	$9,529.33
Rate for Payer: UnitedHealthcare Commercial	$10,816.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,795.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,443.39
Rate for Payer: Wellcare Medicare Advantage	$10,795.65

DENTAL DISEASES AND DISORDERS

Facility

$21,744.63

Service Code	APR-DRG 1144
Min. Negotiated Rate	$20,892.25
Max. Negotiated Rate	$21,744.63
Rate for Payer: Aetna Better Health Medicaid	$20,892.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,310.10
Rate for Payer: Wellpoint Medicaid Managed Care	$21,744.63

DENTAL DISEASES AND DISORDERS

Facility

$7,485.32

Service Code	APR-DRG 1142
Min. Negotiated Rate	$6,211.29
Max. Negotiated Rate	$7,485.32
Rate for Payer: Aetna Better Health Medicaid	$7,338.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,485.32
Rate for Payer: Wellpoint Medicaid Managed Care	$6,211.29

DENTAL DISEASES AND DISORDERS

Facility

$11,023.00

Service Code	APR-DRG 1143
Min. Negotiated Rate	$10,426.80
Max. Negotiated Rate	$11,023.00
Rate for Payer: Aetna Better Health Medicaid	$10,806.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,023.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10,426.80

DENTAL DISEASES AND DISORDERS

Facility

$5,333.84

Service Code	APR-DRG 1141
Min. Negotiated Rate	$4,431.98
Max. Negotiated Rate	$5,333.84
Rate for Payer: Aetna Better Health Medicaid	$5,229.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,333.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4,431.98

DENTAL PASTE

Facility

$21.15

Hospital Charge Code	60628444
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

DENTAL PASTE

Facility

$21.15

Hospital Charge Code	60628444
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$766.50
Max. Negotiated Rate	$766.50
Rate for Payer: Qualcare PPO/HMO/WC	$766.50

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$664.30
Max. Negotiated Rate	$2,555.00
Rate for Payer: Aetna Commercial	$1,533.00
Rate for Payer: Aetna Medicare Advantage	$1,533.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.05
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	$1,303.05
Rate for Payer: Cigna Commercial	$2,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.30
Rate for Payer: Qualcare PPO/HMO/WC	$766.50

DENTAL TRAUMA UPG LORENZ******

Facility

$22,304.00

Hospital Charge Code	270610974
Hospital Revenue Code	259
Min. Negotiated Rate	$2,899.52
Max. Negotiated Rate	$11,152.00
Rate for Payer: Aetna Commercial	$6,691.20
Rate for Payer: Aetna Medicare Advantage	$6,691.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,687.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,687.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,687.52
Rate for Payer: Cigna Commercial	$11,152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.52
Rate for Payer: Oxford Commercial	$11,152.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,345.60
Rate for Payer: UnitedHealthcare Commercial	$11,152.00

DENTAL TRAUMA UPG LORENZ******

Facility

$22,304.00

Hospital Charge Code	270610974
Hospital Revenue Code	259
Min. Negotiated Rate	$3,345.60
Max. Negotiated Rate	$3,345.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,345.60

DENVAIR 1% CREAM 1.5GM

Facility

$156.00

Hospital Charge Code	60635658
Hospital Revenue Code	250
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$46.80
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.28
Rate for Payer: Oxford Commercial	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$78.00

DENVAIR 1% CREAM 1.5GM

Facility

$156.00

Hospital Charge Code	60635658
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$640.25
Max. Negotiated Rate	$2,462.50
Rate for Payer: Aetna Commercial	$1,477.50
Rate for Payer: Aetna Medicare Advantage	$1,477.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,255.88
Rate for Payer: Cigna Commercial	$2,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.25
Rate for Payer: Oxford Commercial	$2,462.50
Rate for Payer: Qualcare PPO/HMO/WC	$738.75
Rate for Payer: UnitedHealthcare Commercial	$2,462.50

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$738.75
Max. Negotiated Rate	$738.75
Rate for Payer: Qualcare PPO/HMO/WC	$738.75

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$72.60
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Oxford Commercial	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$121.00

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DEODERANT ROLL ON 1.5OZ

Facility

$1.93

Hospital Charge Code	270655587
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

DEODERANT ROLL ON 1.5OZ

Facility

$1.93

Hospital Charge Code	270655587
Hospital Revenue Code	270
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna Commercial	$0.58
Rate for Payer: Aetna Medicare Advantage	$0.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.49
Rate for Payer: Cigna Commercial	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.97

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.51
Rate for Payer: Cigna Commercial	$30.98
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.84
Rate for Payer: Wellcare Medicare Advantage	$30.98

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$31.70

DEOXYCORTICOSTERONE, SERUM

Facility

$212.90

Service Code	HCPCS 82633
Hospital Charge Code	3038106
Hospital Revenue Code	300
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.51
Rate for Payer: Cigna Commercial	$30.98
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.84
Rate for Payer: Wellcare Medicare Advantage	$30.98

DEOXYCORTICOSTERONE, SERUM

Facility

$212.90

Service Code	HCPCS 82633
Hospital Charge Code	3038106
Hospital Revenue Code	300
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$31.93
Rate for Payer: Qualcare PPO/HMO/WC	$31.93

Know your out-of-pocket cost for care.

All Charges