Heights University Hospital

All Charges

Charge

Type

Setting

Price

DESOXIMETASONE 15 GM

Facility

$261.05

Hospital Charge Code	60628376W
Hospital Revenue Code	250
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$39.16

DESOXIMETASONE 15 GM

Facility

$261.05

Hospital Charge Code	60628376W
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$130.53
Rate for Payer: Aetna Commercial	$78.31
Rate for Payer: Aetna Medicare Advantage	$78.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.57
Rate for Payer: Cigna Commercial	$130.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.94
Rate for Payer: Oxford Commercial	$130.53
Rate for Payer: Qualcare PPO/HMO/WC	$39.16
Rate for Payer: UnitedHealthcare Commercial	$130.53

DESOXIMETASONE CRM 15GM

Facility

$122.25

Hospital Charge Code	6001663
Hospital Revenue Code	252
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

DESOXIMETASONE CRM 15GM

Facility

$122.25

Hospital Charge Code	6001663
Hospital Revenue Code	252
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

DESOXIMETASONE CRM 60GM

Facility

$274.60

Hospital Charge Code	6001689
Hospital Revenue Code	252
Min. Negotiated Rate	$41.19
Max. Negotiated Rate	$41.19
Rate for Payer: Qualcare PPO/HMO/WC	$41.19

DESOXIMETASONE CRM 60GM

Facility

$274.60

Hospital Charge Code	6001689
Hospital Revenue Code	252
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$137.30
Rate for Payer: Aetna Commercial	$82.38
Rate for Payer: Aetna Medicare Advantage	$82.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.02
Rate for Payer: Cigna Commercial	$137.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$137.30
Rate for Payer: Qualcare PPO/HMO/WC	$41.19
Rate for Payer: UnitedHealthcare Commercial	$137.30

DESOXIMETASONE OINT 15GM

Facility

$12.80

Hospital Charge Code	6001671
Hospital Revenue Code	252
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

DESOXIMETASONE OINT 15GM

Facility

$12.80

Hospital Charge Code	6001671
Hospital Revenue Code	252
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$6.40

DESOXIMETASONE OINT 60GM

Facility

$274.60

Hospital Charge Code	6001697
Hospital Revenue Code	252
Min. Negotiated Rate	$41.19
Max. Negotiated Rate	$41.19
Rate for Payer: Qualcare PPO/HMO/WC	$41.19

DESOXIMETASONE OINT 60GM

Facility

$274.60

Hospital Charge Code	6001697
Hospital Revenue Code	252
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$137.30
Rate for Payer: Aetna Commercial	$82.38
Rate for Payer: Aetna Medicare Advantage	$82.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.02
Rate for Payer: Cigna Commercial	$137.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$137.30
Rate for Payer: Qualcare PPO/HMO/WC	$41.19
Rate for Payer: UnitedHealthcare Commercial	$137.30

DESTROY ANAL LESN SMP,SURG EXC

Facility

$17,947.70

Service Code	HCPCS 46922
Hospital Charge Code	1600000537
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,609.93
Rate for Payer: Aetna Commercial	$5,384.31
Rate for Payer: Aetna Medicare Advantage	$5,384.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,576.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,576.66
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	$4,576.66
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,333.20
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,692.16
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DESTROY ANAL LESN SMP,SURG EXC

Facility

$17,947.70

Service Code	HCPCS 46922
Hospital Charge Code	1600000537
Hospital Revenue Code	360
Min. Negotiated Rate	$2,692.16
Max. Negotiated Rate	$2,692.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,692.16

DESTROY CERV/THOR FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64633
Hospital Charge Code	321564633
Hospital Revenue Code	361
Min. Negotiated Rate	$1,401.76
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$3,234.83
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,401.76
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DESTROY CERV/THOR FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64633
Hospital Charge Code	321564633
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY C/TH FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64634
Hospital Charge Code	321564634
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY C/TH FACET JNT ADDL

Facility

$18,351.40

Service Code	HCPCS 64634
Hospital Charge Code	160000250
Hospital Revenue Code	360
Min. Negotiated Rate	$2,752.71
Max. Negotiated Rate	$2,752.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71

DESTROY C/TH FACET JNT ADDL

Facility

$18,351.40

Service Code	HCPCS 64634
Hospital Charge Code	160000250
Hospital Revenue Code	360
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$5,505.42
Rate for Payer: Aetna Commercial	$5,505.42
Rate for Payer: Aetna Medicare Advantage	$5,505.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.61
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	$4,679.61
Rate for Payer: Cigna Commercial	$62.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,385.68
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DESTROY C/TH FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64634
Hospital Charge Code	321564634
Hospital Revenue Code	361
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$3,234.83
Rate for Payer: Aetna Commercial	$3,234.83
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$62.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,401.76
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DESTROY INTERNAL HEMORRHOID

Facility

$5,616.30

Service Code	HCPCS 46930
Hospital Charge Code	1600000264
Hospital Revenue Code	360
Min. Negotiated Rate	$730.12
Max. Negotiated Rate	$2,849.67
Rate for Payer: Aetna Commercial	$1,684.89
Rate for Payer: Aetna Medicare Advantage	$1,684.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,432.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,432.16
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	$1,432.16
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$730.12
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$842.45
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

DESTROY INTERNAL HEMORRHOID

Facility

$5,616.30

Service Code	HCPCS 46930
Hospital Charge Code	1600000264
Hospital Revenue Code	360
Min. Negotiated Rate	$842.45
Max. Negotiated Rate	$842.45
Rate for Payer: Qualcare PPO/HMO/WC	$842.45

DESTROY L/S FACET JNT ADDL

Facility

$2,817.00

Service Code	HCPCS 64536
Hospital Charge Code	1600000397
Hospital Revenue Code	360
Min. Negotiated Rate	$422.55
Max. Negotiated Rate	$422.55
Rate for Payer: Qualcare PPO/HMO/WC	$422.55

DESTROY L/S FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64636
Hospital Charge Code	321564636
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY L/S FACET JNT ADDL

Facility

$2,817.00

Service Code	HCPCS 64536
Hospital Charge Code	1600000397
Hospital Revenue Code	360
Min. Negotiated Rate	$366.21
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$845.10
Rate for Payer: Aetna Medicare Advantage	$845.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$718.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$718.34
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	$718.34
Rate for Payer: Cigna Commercial	$1,408.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.21
Rate for Payer: Qualcare PPO/HMO/WC	$422.55

DESTROY L/S FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64636
Hospital Charge Code	321564636
Hospital Revenue Code	361
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$3,234.83
Rate for Payer: Aetna Commercial	$3,234.83
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,401.76
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DESTROY LUMB/SAC FACET JNT

Facility

$10,093.90

Service Code	HCPCS 64635
Hospital Charge Code	16000524
Hospital Revenue Code	360
Min. Negotiated Rate	$1,312.21
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$3,028.17
Rate for Payer: Aetna Medicare Advantage	$3,028.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,573.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,573.94
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	$2,573.94
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.21
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,514.09
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

Know your out-of-pocket cost for care.

All Charges