Heights University Hospital

All Charges

Charge

Type

Setting

Price

FELBAMATE

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38476778
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	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
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

FELBAMATE 600 MG TAB

Facility

$12.40

Hospital Charge Code	60627749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare Advantage	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.16
Rate for Payer: Cigna Commercial	$6.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$6.20

FELBAMATE 600 MG TAB

Facility

$12.40

Hospital Charge Code	60627749
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

FELBATOL

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900414
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FELBATOL

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900414
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	$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	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

FELBATOL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634913
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FELBATOL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634913
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

FELDENE/10MG/CAP

Facility

$8.00

Hospital Charge Code	60634225
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

FELDENE/10MG/CAP

Facility

$8.00

Hospital Charge Code	60634225
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FELDENE/20MG/CAP

Facility

$13.00

Hospital Charge Code	60632970
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

FELDENE/20MG/CAP

Facility

$13.00

Hospital Charge Code	60632970
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FELDENE/20MG/CAP

Facility

$13.00

Hospital Charge Code	60632969
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FELDENE/20MG/CAP

Facility

$13.00

Hospital Charge Code	60632969
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

FELODIPINE 10 MG ER

Facility

$14.80

Hospital Charge Code	60629921
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

FELODIPINE 10 MG ER

Facility

$14.80

Hospital Charge Code	60629921
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial	$4.44
Rate for Payer: Aetna Medicare Advantage	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$7.40

FELODIPINE 5 MG ER

Facility

$8.25

Hospital Charge Code	60629920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna Medicare Advantage	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.07
Rate for Payer: Oxford Commercial	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$4.12

FELODIPINE 5 MG ER

Facility

$8.25

Hospital Charge Code	60629920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

FELT ADHESIVE BCKG 1/4RL 68926

Facility

$236.20

Hospital Charge Code	270640902W
Hospital Revenue Code	272
Min. Negotiated Rate	$30.71
Max. Negotiated Rate	$118.10
Rate for Payer: Aetna Commercial	$70.86
Rate for Payer: Aetna Medicare Advantage	$70.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.23
Rate for Payer: Cigna Commercial	$118.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.71
Rate for Payer: Oxford Commercial	$118.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.43
Rate for Payer: UnitedHealthcare Commercial	$118.10

FELT ADHESIVE BCKG 1/4RL 68926

Facility

$236.20

Hospital Charge Code	270640902W
Hospital Revenue Code	272
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$35.43
Rate for Payer: Qualcare PPO/HMO/WC	$35.43

FELT MDX TEFLON 4X4 007836

Facility

$500.00

Hospital Charge Code	270601104
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FELT MDX TEFLON 4X4 007836

Facility

$500.00

Hospital Charge Code	270601104
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FELT ORTH 1/2TH 21/36

Facility

$740.00

Hospital Charge Code	270300910
Hospital Revenue Code	270
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

FELT ORTH 1/2TH 21/36

Facility

$740.00

Hospital Charge Code	270300910
Hospital Revenue Code	270
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$370.00
Rate for Payer: Aetna Commercial	$222.00
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.70
Rate for Payer: Cigna Commercial	$370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Oxford Commercial	$370.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$370.00

FELT SURGICAL SUPPORT 4x4

Facility

$51.45

Hospital Charge Code	270654566
Hospital Revenue Code	272
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$25.73
Rate for Payer: Aetna Commercial	$15.44
Rate for Payer: Aetna Medicare Advantage	$15.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$25.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.69
Rate for Payer: Oxford Commercial	$25.73
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$25.73

FELT SURGICAL SUPPORT 4x4

Facility

$51.45

Hospital Charge Code	270654566
Hospital Revenue Code	272
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

Know your out-of-pocket cost for care.

All Charges