Heights University Hospital

All Charges

Charge

Type

Setting

Price

DERMAZIP****

Facility

$72.00

Hospital Charge Code	1800119
Hospital Revenue Code	279
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$815.25
Max. Negotiated Rate	$2,717.50
Rate for Payer: Aetna Commercial	$1,630.50
Rate for Payer: Aetna Medicare Advantage	$1,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,385.92
Rate for Payer: Cigna Commercial	$2,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: Qualcare PPO/HMO/WC	$815.25

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$815.25
Max. Negotiated Rate	$1,315.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: Qualcare PPO/HMO/WC	$815.25

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$2,415.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$111.81
Rate for Payer: Aetna Commercial	$67.08
Rate for Payer: Aetna Medicare Advantage	$67.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.02
Rate for Payer: Cigna Commercial	$111.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$54.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54

DERMOPLAST 20%/82.5ML

Facility

$26.00

Hospital Charge Code	60632801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

DERMOPLAST 20%/82.5ML

Facility

$26.00

Hospital Charge Code	60632801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$13.00

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$9.75
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: Oxford Commercial	$16.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$16.25

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$4,975.00
Rate for Payer: Aetna Commercial	$2,985.00
Rate for Payer: Aetna Medicare Advantage	$2,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,537.25
Rate for Payer: Cigna Commercial	$4,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,407.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$1,928.61
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$54.80
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$126.45
Rate for Payer: Aetna Medicare Advantage	$126.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.48
Rate for Payer: Cigna Commercial	$210.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.80
Rate for Payer: Oxford Commercial	$210.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.23
Rate for Payer: UnitedHealthcare Commercial	$210.75

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$63.23
Max. Negotiated Rate	$63.23
Rate for Payer: Qualcare PPO/HMO/WC	$63.23

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$1,956.00
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

DESFERAL VL 500MG***

Facility

$40.00

Service Code	HCPCS J0895
Hospital Charge Code	6007744P
Hospital Revenue Code	259
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$8.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

DESFERAL VL 500MG***

Facility

$40.00

Service Code	HCPCS J0895
Hospital Charge Code	6007744P
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

DESFLURANE

Facility

$387.20

Hospital Charge Code	6017214
Hospital Revenue Code	250
Min. Negotiated Rate	$50.34
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna Commercial	$116.16
Rate for Payer: Aetna Medicare Advantage	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.74
Rate for Payer: Cigna Commercial	$193.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Oxford Commercial	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$58.08
Rate for Payer: UnitedHealthcare Commercial	$193.60

DESFLURANE

Facility

$387.20

Hospital Charge Code	6017214
Hospital Revenue Code	250
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$58.08

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$193.22
Max. Negotiated Rate	$193.22
Rate for Payer: Qualcare PPO/HMO/WC	$193.22

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$167.46
Max. Negotiated Rate	$644.07
Rate for Payer: Aetna Commercial	$386.44
Rate for Payer: Aetna Medicare Advantage	$386.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.48
Rate for Payer: Cigna Commercial	$644.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.46
Rate for Payer: Oxford Commercial	$644.07
Rate for Payer: Qualcare PPO/HMO/WC	$193.22
Rate for Payer: UnitedHealthcare Commercial	$644.07

Know your out-of-pocket cost for care.

All Charges