Heights University Hospital

All Charges

Charge

Type

Setting

Price

DOPPLER TRASCRANIAL LIMITED

Facility

$906.00

Service Code	HCPCS 93888
Hospital Charge Code	5300088
Hospital Revenue Code	921
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Qualcare PPO/HMO/WC	$135.90

DOPPLER TRASCRANIAL LIMITED

Facility

$906.00

Service Code	HCPCS 93888
Hospital Charge Code	5300088
Hospital Revenue Code	921
Min. Negotiated Rate	$117.78
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$271.80
Rate for Payer: Aetna Medicare Advantage	$271.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.03
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.78
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.90
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

DOPPLER UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
Hospital Revenue Code	402
Min. Negotiated Rate	$48.64
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$216.30
Rate for Payer: Aetna Medicare Advantage	$216.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.85
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.73
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

DOPPLER UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DOPRAM INJECTION/20MG/ML

Facility

$266.00

Hospital Charge Code	60634259
Hospital Revenue Code	636
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$64.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.37
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

DOPRAM INJECTION/20MG/ML

Facility

$266.00

Hospital Charge Code	60634259
Hospital Revenue Code	636
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.37
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

DORIPENEM

Facility

$230.00

Hospital Charge Code	60629962
Hospital Revenue Code	636
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$69.00
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

DORIPENEM

Facility

$230.00

Hospital Charge Code	60629962
Hospital Revenue Code	636
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$113.19
Max. Negotiated Rate	$182.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$226.39
Rate for Payer: Aetna Commercial	$226.39
Rate for Payer: Aetna Medicare Advantage	$226.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.43
Rate for Payer: Cigna Commercial	$55.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$38,152.85

Service Code	APR-DRG 3041
Min. Negotiated Rate	$26,647.94
Max. Negotiated Rate	$38,152.85
Rate for Payer: Aetna Better Health Medicaid	$37,404.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$38,152.85
Rate for Payer: Wellpoint Medicaid Managed Care	$26,647.94

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$96,482.42

Service Code	APR-DRG 3044
Min. Negotiated Rate	$80,057.45
Max. Negotiated Rate	$96,482.42
Rate for Payer: Aetna Better Health Medicaid	$94,590.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$96,482.42
Rate for Payer: Wellpoint Medicaid Managed Care	$80,057.45

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$62,774.43

Service Code	APR-DRG 3043
Min. Negotiated Rate	$48,068.06
Max. Negotiated Rate	$62,774.43
Rate for Payer: Aetna Better Health Medicaid	$61,543.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$62,774.43
Rate for Payer: Wellpoint Medicaid Managed Care	$48,068.06

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$45,142.43

Service Code	APR-DRG 3042
Min. Negotiated Rate	$31,916.61
Max. Negotiated Rate	$45,142.43
Rate for Payer: Aetna Better Health Medicaid	$44,257.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,142.43
Rate for Payer: Wellpoint Medicaid Managed Care	$31,916.61

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$55,370.57

Service Code	APR-DRG 3031
Min. Negotiated Rate	$43,840.81
Max. Negotiated Rate	$55,370.57
Rate for Payer: Aetna Better Health Medicaid	$54,284.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$55,370.57
Rate for Payer: Wellpoint Medicaid Managed Care	$43,840.81

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$90,817.14

Service Code	APR-DRG 3033
Min. Negotiated Rate	$77,291.65
Max. Negotiated Rate	$90,817.14
Rate for Payer: Aetna Better Health Medicaid	$89,036.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$90,817.14
Rate for Payer: Wellpoint Medicaid Managed Care	$77,291.65

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$65,901.97

Service Code	APR-DRG 3032
Min. Negotiated Rate	$52,755.16
Max. Negotiated Rate	$65,901.97
Rate for Payer: Aetna Better Health Medicaid	$64,609.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,901.97
Rate for Payer: Wellpoint Medicaid Managed Care	$52,755.16

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$132,833.41

Service Code	APR-DRG 3034
Min. Negotiated Rate	$104,994.75
Max. Negotiated Rate	$132,833.41
Rate for Payer: Aetna Better Health Medicaid	$130,228.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$132,833.41
Rate for Payer: Wellpoint Medicaid Managed Care	$104,994.75

DORSAL SPINE 4VW

Facility

$204.00

Hospital Charge Code	2009350
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

DORSAL SPINE 4VW

Facility

$204.00

Hospital Charge Code	2009350
Hospital Revenue Code	320
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$92.50

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$80.17
Max. Negotiated Rate	$308.33
Rate for Payer: Aetna Commercial	$185.00
Rate for Payer: Aetna Medicare Advantage	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.25
Rate for Payer: Cigna Commercial	$308.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.17
Rate for Payer: Oxford Commercial	$308.33
Rate for Payer: Qualcare PPO/HMO/WC	$92.50
Rate for Payer: UnitedHealthcare Commercial	$308.33

DORZOLAMIDE HCL 2% OPH SOLN 5M

Facility

$382.92

Hospital Charge Code	606350921
Hospital Revenue Code	250
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$191.46
Rate for Payer: Aetna Commercial	$114.88
Rate for Payer: Aetna Medicare Advantage	$114.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.64
Rate for Payer: Cigna Commercial	$191.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.78
Rate for Payer: Oxford Commercial	$191.46
Rate for Payer: Qualcare PPO/HMO/WC	$57.44
Rate for Payer: UnitedHealthcare Commercial	$191.46

DORZOLAMIDE HCL 2% OPH SOLN 5M

Facility

$382.92

Hospital Charge Code	606350921
Hospital Revenue Code	250
Min. Negotiated Rate	$57.44
Max. Negotiated Rate	$57.44
Rate for Payer: Qualcare PPO/HMO/WC	$57.44

DORZOLAMIDE OPH SOL .2% 5ML

Facility

$97.30

Hospital Charge Code	6017370
Hospital Revenue Code	252
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

Know your out-of-pocket cost for care.

All Charges