Heights University Hospital

All Charges

Charge

Type

Setting

Price

DISIPAL/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634369
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,028.25
Rate for Payer: Aetna Commercial	$1,028.25
Rate for Payer: Aetna Medicare Advantage	$1,028.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.01
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: Qualcare PPO/HMO/WC	$514.12

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$514.12
Max. Negotiated Rate	$829.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: Qualcare PPO/HMO/WC	$514.12

DISK MAGNETIC OPTICAL

Facility

$47.50

Hospital Charge Code	270657782
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

DISK MAGNETIC OPTICAL

Facility

$47.50

Hospital Charge Code	270657782
Hospital Revenue Code	270
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$23.75

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$9.61
Rate for Payer: Aetna Medicare Advantage	$9.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.17
Rate for Payer: Cigna Commercial	$16.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.02

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.79

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: Aetna Medicare Advantage	$6.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.78
Rate for Payer: Cigna Commercial	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: Oxford Commercial	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$11.32

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$5.89

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

DISOPYRAMIDE, SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3007374
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

DISOPYRAMIDE, SERUM

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3007374
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$8,843.41

Service Code	APR-DRG 2841
Min. Negotiated Rate	$5,858.52
Max. Negotiated Rate	$8,843.41
Rate for Payer: Aetna Better Health Medicaid	$8,670.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,843.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5,858.52

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$16,139.17

Service Code	APR-DRG 2843
Min. Negotiated Rate	$11,261.07
Max. Negotiated Rate	$16,139.17
Rate for Payer: Aetna Better Health Medicaid	$15,822.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,139.17
Rate for Payer: Wellpoint Medicaid Managed Care	$11,261.07

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$11,522.96

Service Code	APR-DRG 2842
Min. Negotiated Rate	$7,814.43
Max. Negotiated Rate	$11,522.96
Rate for Payer: Aetna Better Health Medicaid	$11,297.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,522.96
Rate for Payer: Wellpoint Medicaid Managed Care	$7,814.43

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$27,475.34

Service Code	APR-DRG 2844
Min. Negotiated Rate	$22,295.83
Max. Negotiated Rate	$27,475.34
Rate for Payer: Aetna Better Health Medicaid	$26,936.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,475.34
Rate for Payer: Wellpoint Medicaid Managed Care	$22,295.83

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$10,808.10

Service Code	APR-DRG 7583
Min. Negotiated Rate	$8,053.88
Max. Negotiated Rate	$10,808.10
Rate for Payer: Aetna Better Health Medicaid	$10,596.18
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,808.10
Rate for Payer: Wellpoint Medicaid Managed Care	$8,053.88

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$6,180.67

Service Code	APR-DRG 7582
Min. Negotiated Rate	$4,803.92
Max. Negotiated Rate	$6,180.67
Rate for Payer: Aetna Better Health Medicaid	$6,059.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,180.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4,803.92

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$14,226.39

Service Code	APR-DRG 7584
Min. Negotiated Rate	$10,643.87
Max. Negotiated Rate	$14,226.39
Rate for Payer: Aetna Better Health Medicaid	$13,947.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,226.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10,643.87

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$4,845.08

Service Code	APR-DRG 7581
Min. Negotiated Rate	$4,041.95
Max. Negotiated Rate	$4,845.08
Rate for Payer: Aetna Better Health Medicaid	$4,750.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,845.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4,041.95

Know your out-of-pocket cost for care.

All Charges