Heights University Hospital

All Charges

Charge

Type

Setting

Price

DIFLUCAN/100MG/TAB

Facility

$48.00

Hospital Charge Code	60632839
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIFLUCAN/200MG/NS 0.9%/20

Facility

$389.00

Hospital Charge Code	60632842
Hospital Revenue Code	250
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

DIFLUCAN/200MG/NS 0.9%/20

Facility

$389.00

Hospital Charge Code	60632842
Hospital Revenue Code	250
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.57
Rate for Payer: Oxford Commercial	$194.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$194.50

DIFLUCAN/200MG/TAB

Facility

$80.00

Hospital Charge Code	60632840
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

DIFLUCAN/200MG/TAB

Facility

$80.00

Hospital Charge Code	60632840
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$19.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$24.12
Rate for Payer: Aetna Medicare Advantage	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.50
Rate for Payer: Cigna Commercial	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

DIFLUCAN PRENIRED/400MG

Facility

$645.00

Hospital Charge Code	60634707
Hospital Revenue Code	636
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$156.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

DIFLUCAN PRENIRED/400MG

Facility

$645.00

Hospital Charge Code	60634707
Hospital Revenue Code	636
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$193.50
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.09
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

DIFLUNISAL 500 MG TAB

Facility

$13.65

Hospital Charge Code	60628605
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

DIFLUNISAL 500 MG TAB

Facility

$13.65

Hospital Charge Code	60628605
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

DIGESTIVE MALIGNANCY

Facility

$9,655.16

Service Code	APR-DRG 2401
Min. Negotiated Rate	$6,529.15
Max. Negotiated Rate	$9,655.16
Rate for Payer: Aetna Better Health Medicaid	$9,465.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,655.16
Rate for Payer: Wellpoint Medicaid Managed Care	$6,529.15

DIGESTIVE MALIGNANCY

Facility

$25,294.30

Service Code	APR-DRG 2404
Min. Negotiated Rate	$22,578.84
Max. Negotiated Rate	$25,294.30
Rate for Payer: Aetna Better Health Medicaid	$24,798.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,294.30
Rate for Payer: Wellpoint Medicaid Managed Care	$22,578.84

DIGESTIVE MALIGNANCY

Facility

$15,460.86

Service Code	APR-DRG 2403
Min. Negotiated Rate	$12,326.99
Max. Negotiated Rate	$15,460.86
Rate for Payer: Aetna Better Health Medicaid	$15,157.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,460.86
Rate for Payer: Wellpoint Medicaid Managed Care	$12,326.99

DIGESTIVE MALIGNANCY

Facility

$11,569.26

Service Code	APR-DRG 2402
Min. Negotiated Rate	$8,368.05
Max. Negotiated Rate	$11,569.26
Rate for Payer: Aetna Better Health Medicaid	$11,342.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,569.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8,368.05

DIGESTIVE MALIGNANCY WITH CC

Facility

$46,931.76

Service Code	MSDRG 375
Min. Negotiated Rate	$13,199.86
Max. Negotiated Rate	$46,931.76
Rate for Payer: Aetna Commercial	$40,787.57
Rate for Payer: Aetna Medicare Advantage	$13,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,080.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,080.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,643.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,080.40
Rate for Payer: Cigna Commercial	$26,031.80
Rate for Payer: Cigna Medicare Advantage	$15,643.92
Rate for Payer: Clover Medicare Advantage	$14,861.72
Rate for Payer: EmblemHealth Commercial	$46,931.76
Rate for Payer: Humana Medicare Advantage	$16,113.24
Rate for Payer: Oxford Commercial	$16,269.12
Rate for Payer: UnitedHealthcare Commercial	$18,466.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,643.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,582.56
Rate for Payer: Wellcare Medicare Advantage	$15,643.92

DIGESTIVE MALIGNANCY WITH MCC

Facility

$73,899.57

Service Code	MSDRG 374
Min. Negotiated Rate	$23,338.74
Max. Negotiated Rate	$73,899.57
Rate for Payer: Aetna Commercial	$72,116.71
Rate for Payer: Aetna Medicare Advantage	$23,338.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57,890.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57,890.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,633.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57,890.70
Rate for Payer: Cigna Commercial	$46,026.96
Rate for Payer: Cigna Medicare Advantage	$24,633.19
Rate for Payer: Clover Medicare Advantage	$23,401.53
Rate for Payer: EmblemHealth Commercial	$73,899.57
Rate for Payer: Humana Medicare Advantage	$25,372.19
Rate for Payer: Oxford Commercial	$28,765.51
Rate for Payer: UnitedHealthcare Commercial	$32,651.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,633.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26,111.18
Rate for Payer: Wellcare Medicare Advantage	$24,633.19

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$38,650.71

Service Code	MSDRG 376
Min. Negotiated Rate	$10,086.50
Max. Negotiated Rate	$38,650.71
Rate for Payer: Aetna Commercial	$31,167.28
Rate for Payer: Aetna Medicare Advantage	$10,086.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,534.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,534.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,883.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,534.63
Rate for Payer: Cigna Commercial	$19,891.86
Rate for Payer: Cigna Medicare Advantage	$12,883.57
Rate for Payer: Clover Medicare Advantage	$12,239.39
Rate for Payer: EmblemHealth Commercial	$38,650.71
Rate for Payer: Humana Medicare Advantage	$13,270.08
Rate for Payer: Oxford Commercial	$12,431.83
Rate for Payer: UnitedHealthcare Commercial	$14,111.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,883.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13,656.58
Rate for Payer: Wellcare Medicare Advantage	$12,883.57

DIGIBIND/40MG

Facility

$1,957.00

Hospital Charge Code	60632843
Hospital Revenue Code	636
Min. Negotiated Rate	$293.55
Max. Negotiated Rate	$473.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: Qualcare PPO/HMO/WC	$293.55

DIGIBIND/40MG

Facility

$1,957.00

Hospital Charge Code	60632843
Hospital Revenue Code	636
Min. Negotiated Rate	$293.55
Max. Negotiated Rate	$978.50
Rate for Payer: Aetna Commercial	$587.10
Rate for Payer: Aetna Medicare Advantage	$587.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$499.04
Rate for Payer: Cigna Commercial	$978.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: Qualcare PPO/HMO/WC	$293.55

DIGIFAB 40MG VL

Facility

$2,646.00

Hospital Charge Code	60635568
Hospital Revenue Code	636
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$640.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.33
Rate for Payer: Qualcare PPO/HMO/WC	$396.90

DIGIFAB 40MG VL

Facility

$2,646.00

Hospital Charge Code	60635568
Hospital Revenue Code	636
Min. Negotiated Rate	$396.90
Max. Negotiated Rate	$1,323.00
Rate for Payer: Aetna Commercial	$793.80
Rate for Payer: Aetna Medicare Advantage	$793.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$674.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$674.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$674.73
Rate for Payer: Cigna Commercial	$1,323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.33
Rate for Payer: Qualcare PPO/HMO/WC	$396.90

DIGITAL DIAG ADD VIEWS BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061455
Hospital Revenue Code	401
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$235.20
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.92
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

DIGITAL DIAG ADD VIEWS BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061455
Hospital Revenue Code	401
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

DIGITAL DIAG ADD VIEWS LT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061457
Hospital Revenue Code	401
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$131.40
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.94
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

Know your out-of-pocket cost for care.

All Charges