Heights University Hospital

All Charges

Charge

Type

Setting

Price

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$6,450.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

DSE TUBING

Facility

$9.29

Hospital Charge Code	270658599
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$2.79
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Oxford Commercial	$4.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$4.64

DSE TUBING

Facility

$9.29

Hospital Charge Code	270658599
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$779.00
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$779.00

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,362.12

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$697.08
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$1,608.64
Rate for Payer: Aetna Medicare Advantage	$1,608.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,367.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,367.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,367.34
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.08
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$804.32
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,362.12

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$804.32
Max. Negotiated Rate	$804.32
Rate for Payer: Qualcare PPO/HMO/WC	$804.32

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$930.90
Rate for Payer: Aetna Medicare Advantage	$930.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$791.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$791.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$791.26
Rate for Payer: Cigna Commercial	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.39
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.45
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$465.45
Max. Negotiated Rate	$465.45
Rate for Payer: Qualcare PPO/HMO/WC	$465.45

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$1,209.01
Max. Negotiated Rate	$1,209.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$1,047.81
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,418.01
Rate for Payer: Aetna Medicare Advantage	$2,418.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,055.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,055.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,055.31
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.81
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DTAP 5ML

Facility

$140.20

Hospital Charge Code	6017859
Hospital Revenue Code	250
Min. Negotiated Rate	$21.03
Max. Negotiated Rate	$21.03
Rate for Payer: Qualcare PPO/HMO/WC	$21.03

DTAP 5ML

Facility

$140.20

Hospital Charge Code	6017859
Hospital Revenue Code	250
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$70.10
Rate for Payer: Aetna Commercial	$42.06
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.75
Rate for Payer: Cigna Commercial	$70.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.23
Rate for Payer: Oxford Commercial	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$21.03
Rate for Payer: UnitedHealthcare Commercial	$70.10

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$26.19
Max. Negotiated Rate	$26.19
Rate for Payer: Qualcare PPO/HMO/WC	$26.19

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$52.38
Rate for Payer: Aetna Medicare Advantage	$52.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.52
Rate for Payer: Cigna Commercial	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$87.30
Rate for Payer: Qualcare PPO/HMO/WC	$26.19
Rate for Payer: UnitedHealthcare Commercial	$87.30

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$82.75
Rate for Payer: Aetna Commercial	$49.65
Rate for Payer: Aetna Medicare Advantage	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.20
Rate for Payer: Cigna Commercial	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.51
Rate for Payer: Oxford Commercial	$82.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.82
Rate for Payer: UnitedHealthcare Commercial	$82.75

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$24.82
Rate for Payer: Qualcare PPO/HMO/WC	$24.82

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$133.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$276.51
Rate for Payer: Aetna Commercial	$165.91
Rate for Payer: Aetna Medicare Advantage	$165.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.02
Rate for Payer: Cigna Commercial	$276.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$60.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$125.95
Rate for Payer: Aetna Commercial	$75.57
Rate for Payer: Aetna Medicare Advantage	$75.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.23
Rate for Payer: Cigna Commercial	$125.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$70.28
Rate for Payer: Aetna Commercial	$70.28
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$39.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$56.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

DTIC/200MG/IV

Facility

$104.00

Hospital Charge Code	60634665
Hospital Revenue Code	250
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

Know your out-of-pocket cost for care.

All Charges