Heights University Hospital

All Charges

Charge

Type

Setting

Price

DIVALPROEX CAP 125MG SPRINKLE

Facility

$12.06

Service Code	NDC 74611411
Hospital Charge Code	60627747
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$6.03

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$11.26
Rate for Payer: Aetna Commercial	$6.75
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$11.26
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.26

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.93

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.08
Rate for Payer: Cigna Commercial	$19.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$19.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.93
Rate for Payer: UnitedHealthcare Commercial	$19.77

DIVALPROEX TAB 250MG

Facility

$7.70

Hospital Charge Code	6017503
Hospital Revenue Code	252
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

DIVALPROEX TAB 250MG

Facility

$7.70

Hospital Charge Code	6017503
Hospital Revenue Code	252
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$9,320.88

Service Code	APR-DRG 2442
Min. Negotiated Rate	$6,230.71
Max. Negotiated Rate	$9,320.88
Rate for Payer: Aetna Better Health Medicaid	$9,138.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,320.88
Rate for Payer: Wellpoint Medicaid Managed Care	$6,230.71

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$24,726.92

Service Code	APR-DRG 2444
Min. Negotiated Rate	$21,465.43
Max. Negotiated Rate	$24,726.92
Rate for Payer: Aetna Better Health Medicaid	$24,242.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,726.92
Rate for Payer: Wellpoint Medicaid Managed Care	$21,465.43

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$14,101.40

Service Code	APR-DRG 2443
Min. Negotiated Rate	$9,457.08
Max. Negotiated Rate	$14,101.40
Rate for Payer: Aetna Better Health Medicaid	$13,824.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,101.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9,457.08

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$7,120.18

Service Code	APR-DRG 2441
Min. Negotiated Rate	$4,761.45
Max. Negotiated Rate	$7,120.18
Rate for Payer: Aetna Better Health Medicaid	$6,980.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,120.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4,761.45

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$355.08
Max. Negotiated Rate	$1,365.68
Rate for Payer: Aetna Commercial	$819.41
Rate for Payer: Aetna Medicare Advantage	$819.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.50
Rate for Payer: Cigna Commercial	$1,365.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.08
Rate for Payer: Oxford Commercial	$1,365.68
Rate for Payer: Qualcare PPO/HMO/WC	$409.71
Rate for Payer: UnitedHealthcare Commercial	$1,365.68

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$409.71
Max. Negotiated Rate	$409.71
Rate for Payer: Qualcare PPO/HMO/WC	$409.71

D-LACTATE

Facility

$1,057.50

Hospital Charge Code	3035126
Hospital Revenue Code	301
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$528.75
Rate for Payer: Aetna Commercial	$317.25
Rate for Payer: Aetna Medicare Advantage	$317.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.66
Rate for Payer: Cigna Commercial	$528.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.62
Rate for Payer: UnitedHealthcare Commercial	$114.00

D-LACTATE

Facility

$1,057.50

Hospital Charge Code	3035126
Hospital Revenue Code	301
Min. Negotiated Rate	$158.62
Max. Negotiated Rate	$158.62
Rate for Payer: Qualcare PPO/HMO/WC	$158.62

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.49
Rate for Payer: Aetna Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.39
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: Cigna Medicare Advantage	$5.79
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.19
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.26
Rate for Payer: Wellcare Medicare Advantage	$11.57

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$95.19
Rate for Payer: Qualcare PPO/HMO/WC	$95.19

DLU ENDO GIA 30 2.5 30805L

Facility

$1,172.85

Hospital Charge Code	270600119
Hospital Revenue Code	272
Min. Negotiated Rate	$175.93
Max. Negotiated Rate	$175.93
Rate for Payer: Qualcare PPO/HMO/WC	$175.93

DLU ENDO GIA 30 2.5 30805L

Facility

$1,172.85

Hospital Charge Code	270600119
Hospital Revenue Code	272
Min. Negotiated Rate	$152.47
Max. Negotiated Rate	$586.42
Rate for Payer: Aetna Commercial	$351.86
Rate for Payer: Aetna Medicare Advantage	$351.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.08
Rate for Payer: Cigna Commercial	$586.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.47
Rate for Payer: Oxford Commercial	$586.42
Rate for Payer: Qualcare PPO/HMO/WC	$175.93
Rate for Payer: UnitedHealthcare Commercial	$586.42

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$64.67
Max. Negotiated Rate	$248.74
Rate for Payer: Aetna Commercial	$149.24
Rate for Payer: Aetna Medicare Advantage	$149.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.86
Rate for Payer: Cigna Commercial	$248.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.67
Rate for Payer: Oxford Commercial	$248.74
Rate for Payer: Qualcare PPO/HMO/WC	$74.62
Rate for Payer: UnitedHealthcare Commercial	$248.74

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

DLU ENDO GIA 60 2.5 030314

Facility

$1,986.45

Hospital Charge Code	270600125
Hospital Revenue Code	272
Min. Negotiated Rate	$258.24
Max. Negotiated Rate	$993.23
Rate for Payer: Aetna Commercial	$595.93
Rate for Payer: Aetna Medicare Advantage	$595.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.54
Rate for Payer: Cigna Commercial	$993.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.24
Rate for Payer: Oxford Commercial	$993.23
Rate for Payer: Qualcare PPO/HMO/WC	$297.97
Rate for Payer: UnitedHealthcare Commercial	$993.23

DLU ENDO GIA 60 2.5 030314

Facility

$1,986.45

Hospital Charge Code	270600125
Hospital Revenue Code	272
Min. Negotiated Rate	$297.97
Max. Negotiated Rate	$297.97
Rate for Payer: Qualcare PPO/HMO/WC	$297.97

DLU ENDO GIA 60 3.5 30312L

Facility

$816.85

Hospital Charge Code	270600123
Hospital Revenue Code	272
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$408.43
Rate for Payer: Aetna Commercial	$245.06
Rate for Payer: Aetna Medicare Advantage	$245.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.30
Rate for Payer: Cigna Commercial	$408.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.19
Rate for Payer: Oxford Commercial	$408.43
Rate for Payer: Qualcare PPO/HMO/WC	$122.53
Rate for Payer: UnitedHealthcare Commercial	$408.43

DLU ENDO GIA 60 3.5 30312L

Facility

$816.85

Hospital Charge Code	270600123
Hospital Revenue Code	272
Min. Negotiated Rate	$122.53
Max. Negotiated Rate	$122.53
Rate for Payer: Qualcare PPO/HMO/WC	$122.53

Know your out-of-pocket cost for care.

All Charges