Heights University Hospital

All Charges

Charge

Type

Setting

Price

ALPHA-GLOBIN COMPLETE

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900030
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$1,104.15
Rate for Payer: Aetna Commercial	$976.37
Rate for Payer: Aetna Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$301.35
Rate for Payer: Cigna Medicare Advantage	$150.68
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$319.43
Rate for Payer: Wellcare Medicare Advantage	$301.35

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$1,104.15
Rate for Payer: Aetna Commercial	$976.37
Rate for Payer: Aetna Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$301.35
Rate for Payer: Cigna Medicare Advantage	$150.68
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$319.43
Rate for Payer: Wellcare Medicare Advantage	$301.35

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$3,483.75
Max. Negotiated Rate	$11,612.50
Rate for Payer: Aetna Commercial	$6,967.50
Rate for Payer: Aetna Medicare Advantage	$6,967.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,922.38
Rate for Payer: Cigna Commercial	$11,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$3,483.75
Max. Negotiated Rate	$5,620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.75
Max. Negotiated Rate	$6,572.50
Rate for Payer: Aetna Commercial	$3,943.50
Rate for Payer: Aetna Medicare Advantage	$3,943.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.97
Rate for Payer: Cigna Commercial	$6,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.75
Max. Negotiated Rate	$3,181.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Medicare Advantage	$14.12
Rate for Payer: Aetna Commercial	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.74
Rate for Payer: Cigna Commercial	$14.12
Rate for Payer: Cigna Medicare Advantage	$7.06
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.97
Rate for Payer: Wellcare Medicare Advantage	$14.12

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALPHA-THALASSEMIA

Facility

$200.00

Service Code	HCPCS 81257
Hospital Charge Code	3038117
Hospital Revenue Code	310
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

ALPHA-THALASSEMIA

Facility

$200.00

Service Code	HCPCS 81257
Hospital Charge Code	3038117
Hospital Revenue Code	310
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$374.68
Rate for Payer: Aetna Commercial	$331.32
Rate for Payer: Aetna Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.68
Rate for Payer: Cigna Commercial	$102.26
Rate for Payer: Cigna Medicare Advantage	$51.13
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$108.40
Rate for Payer: Wellcare Medicare Advantage	$102.26

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$51.13
Max. Negotiated Rate	$374.68
Rate for Payer: Aetna Commercial	$331.32
Rate for Payer: Aetna Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.68
Rate for Payer: Cigna Commercial	$102.26
Rate for Payer: Cigna Medicare Advantage	$51.13
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$108.40
Rate for Payer: Wellcare Medicare Advantage	$102.26

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$348.45
Max. Negotiated Rate	$348.45
Rate for Payer: Qualcare PPO/HMO/WC	$348.45

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$2.15
Rate for Payer: Aetna Commercial	$1.29
Rate for Payer: Aetna Medicare Advantage	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.09
Rate for Payer: Cigna Commercial	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.56
Rate for Payer: Oxford Commercial	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$2.15

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$1.61
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$2.68

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

ALPRAZOLAM 1.25MG

Facility

$1.95

Hospital Charge Code	6020028
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

ALPRAZOLAM 1.25MG

Facility

$1.95

Hospital Charge Code	6020028
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

ALPRAZOLAM TAB 0.125 MG/0.5

Facility

$3.20

Hospital Charge Code	60628921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

ALPRAZOLAM TAB 0.125 MG/0.5

Facility

$3.20

Hospital Charge Code	60628921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

Know your out-of-pocket cost for care.

All Charges