Heights University Hospital

All Charges

Charge

Type

Setting

Price

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$17.53
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Oxford Commercial	$29.21
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$29.21

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$17.53
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Oxford Commercial	$29.21
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$29.21

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
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	$9.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
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

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$1,605.26
Max. Negotiated Rate	$1,605.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$854.65
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$3,210.53
Rate for Payer: Aetna Medicare Advantage	$3,210.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.95
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	$2,728.95
Rate for Payer: Cigna Commercial	$854.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.23
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$19.50

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$37.80
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$63.00

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

DUONEB 0.5MG/2.5MG

Facility

$9.20

Hospital Charge Code	60635786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$4.60
Rate for Payer: Aetna Commercial	$2.76
Rate for Payer: Aetna Medicare Advantage	$2.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.35
Rate for Payer: Cigna Commercial	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$4.60

DUONEB 0.5MG/2.5MG

Facility

$9.20

Hospital Charge Code	60635786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

DUOVISC 0.5-0.55 ML

Facility

$1,338.39

Service Code	NDC 8065183150
Hospital Charge Code	60632265
Hospital Revenue Code	250
Min. Negotiated Rate	$200.76
Max. Negotiated Rate	$200.76
Rate for Payer: Qualcare PPO/HMO/WC	$200.76

DUOVISC 0.5-0.55 ML

Facility

$1,338.39

Service Code	NDC 8065183150
Hospital Charge Code	60632265
Hospital Revenue Code	250
Min. Negotiated Rate	$173.99
Max. Negotiated Rate	$669.20
Rate for Payer: Aetna Commercial	$401.52
Rate for Payer: Aetna Medicare Advantage	$401.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$341.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$341.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$341.29
Rate for Payer: Cigna Commercial	$669.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.99
Rate for Payer: Oxford Commercial	$669.20
Rate for Payer: Qualcare PPO/HMO/WC	$200.76
Rate for Payer: UnitedHealthcare Commercial	$669.20

DUOVISC 50 VISCOAT 8065183150

Facility

$445.90

Hospital Charge Code	270632162
Hospital Revenue Code	272
Min. Negotiated Rate	$66.89
Max. Negotiated Rate	$66.89
Rate for Payer: Qualcare PPO/HMO/WC	$66.89

DUOVISC 50 VISCOAT 8065183150

Facility

$445.90

Hospital Charge Code	270632162
Hospital Revenue Code	272
Min. Negotiated Rate	$57.97
Max. Negotiated Rate	$222.95
Rate for Payer: Aetna Commercial	$133.77
Rate for Payer: Aetna Medicare Advantage	$133.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.70
Rate for Payer: Cigna Commercial	$222.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.97
Rate for Payer: Oxford Commercial	$222.95
Rate for Payer: Qualcare PPO/HMO/WC	$66.89
Rate for Payer: UnitedHealthcare Commercial	$222.95

DUPLEX ART IN & OUT FLOWS LIM

Facility

$17,200.00

Service Code	HCPCS 93976
Hospital Charge Code	2101134
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

DUPLEX ART IN & OUT FLOWS LIM

Facility

$17,200.00

Service Code	HCPCS 93976
Hospital Charge Code	2101134
Hospital Revenue Code	921
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

DUPLEX INFLO/OUTFLO BI

Facility

$1,364.48

Service Code	HCPCS 93985
Hospital Charge Code	407693985
Hospital Revenue Code	920
Min. Negotiated Rate	$177.38
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$409.34
Rate for Payer: Aetna Medicare Advantage	$409.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.94
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.38
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.67
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DUPLEX INFLO/OUTFLO BI

Facility

$1,364.48

Service Code	HCPCS 93985
Hospital Charge Code	407693985
Hospital Revenue Code	920
Min. Negotiated Rate	$204.67
Max. Negotiated Rate	$204.67
Rate for Payer: Qualcare PPO/HMO/WC	$204.67

DUPLEX INFLO/OUTFLO UNI

Facility

$656.27

Service Code	HCPCS 93986
Hospital Charge Code	407693986
Hospital Revenue Code	920
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$196.88
Rate for Payer: Aetna Medicare Advantage	$196.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.35
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.32
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.44
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DUPLEX INFLO/OUTFLO UNI

Facility

$656.27

Service Code	HCPCS 93986
Hospital Charge Code	407693986
Hospital Revenue Code	920
Min. Negotiated Rate	$98.44
Max. Negotiated Rate	$98.44
Rate for Payer: Qualcare PPO/HMO/WC	$98.44

DUPLEX SCAN ABD PELVIS RETR

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692155
Hospital Revenue Code	921
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

Know your out-of-pocket cost for care.

All Charges