Heights University Hospital

All Charges

Charge

Type

Setting

Price

DIALYSATE 2 K 3.5 CA SB1003

Facility

$22.45

Hospital Charge Code	270604646
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$11.22

DIALYSATE 2 K 3.5 CA SB1003

Facility

$22.45

Hospital Charge Code	270604646
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

DIALYSATE CAL-0 K-0 BAT SB1030

Facility

$22.45

Hospital Charge Code	270605244
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$11.22

DIALYSATE CAL-0 K-0 BAT SB1030

Facility

$22.45

Hospital Charge Code	270605244
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

DIALYSATE KIT #3

Facility

$26.45

Hospital Charge Code	8200347
Hospital Revenue Code	279
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$7.93
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$13.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$13.22

DIALYSATE KIT #3

Facility

$26.45

Hospital Charge Code	8200347
Hospital Revenue Code	279
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

DIALYSATE O K 2.5 CAL

Facility

$39.25

Hospital Charge Code	8200255
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

DIALYSATE O K 2.5 CAL

Facility

$39.25

Hospital Charge Code	8200255
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$19.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$19.62

DIALYSATE O K 3.5 CAL

Facility

$52.85

Hospital Charge Code	8200263
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

DIALYSATE O K 3.5 CAL

Facility

$52.85

Hospital Charge Code	8200263
Hospital Revenue Code	272
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$15.86
Rate for Payer: Aetna Medicare Advantage	$15.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.48
Rate for Payer: Cigna Commercial	$26.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.87
Rate for Payer: Oxford Commercial	$26.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$26.43

DIALYSATE SORB 10

Facility

$29.65

Hospital Charge Code	8200107
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

DIALYSATE SORB 10

Facility

$29.65

Hospital Charge Code	8200107
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

DIALYSIS

Facility

$1,385.00

Hospital Charge Code	8200057
Hospital Revenue Code	803
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$207.75
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

DIALYSIS

Facility

$988.00

Hospital Charge Code	270607808
Hospital Revenue Code	270
Min. Negotiated Rate	$148.20
Max. Negotiated Rate	$148.20
Rate for Payer: Qualcare PPO/HMO/WC	$148.20

DIALYSIS

Facility

$1,118.00

Hospital Charge Code	27059769
Hospital Revenue Code	271
Min. Negotiated Rate	$167.70
Max. Negotiated Rate	$167.70
Rate for Payer: Qualcare PPO/HMO/WC	$167.70

DIALYSIS

Facility

$150.51

Service Code	HCPCS 90999
Hospital Charge Code	8200040R
Hospital Revenue Code	821
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$22.58
Rate for Payer: Qualcare PPO/HMO/WC	$22.58

DIALYSIS

Facility

$9.00

Hospital Charge Code	270616286
Hospital Revenue Code	270
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

DIALYSIS

Facility

$167.00

Hospital Charge Code	270605309
Hospital Revenue Code	270
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

DIALYSIS

Facility

$147.00

Hospital Charge Code	270615916
Hospital Revenue Code	272
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.11
Rate for Payer: Oxford Commercial	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$73.50

DIALYSIS

Facility

$154.00

Hospital Charge Code	8200081
Hospital Revenue Code	272
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

DIALYSIS

Facility

$364.00

Service Code	HCPCS 90945
Hospital Charge Code	8200067
Hospital Revenue Code	841
Min. Negotiated Rate	$47.32
Max. Negotiated Rate	$2,892.00
Rate for Payer: Aetna Commercial	$109.20
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$993.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.32
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$2,892.00

DIALYSIS

Facility

$615.70

Hospital Charge Code	8200032
Hospital Revenue Code	809
Min. Negotiated Rate	$80.04
Max. Negotiated Rate	$307.85
Rate for Payer: Aetna Commercial	$184.71
Rate for Payer: Aetna Medicare Advantage	$184.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.00
Rate for Payer: Cigna Commercial	$307.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.04
Rate for Payer: Oxford Commercial	$307.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.36
Rate for Payer: UnitedHealthcare Commercial	$307.85

DIALYSIS

Facility

$156.00

Hospital Charge Code	270614258
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

DIALYSIS

Facility

$142.00

Hospital Charge Code	8200495
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DIALYSIS

Facility

$182.00

Hospital Charge Code	270603987
Hospital Revenue Code	270
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$54.60
Rate for Payer: Aetna Medicare Advantage	$54.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.41
Rate for Payer: Cigna Commercial	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.30
Rate for Payer: UnitedHealthcare Commercial	$91.00

Know your out-of-pocket cost for care.

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