Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRIP TROCH COBALT 120009

Facility

$4,130.00

Hospital Charge Code	270646775
Hospital Revenue Code	272
Min. Negotiated Rate	$619.50
Max. Negotiated Rate	$619.50
Rate for Payer: Qualcare PPO/HMO/WC	$619.50

GRISEOFULVIN 125MG/5ML

Facility

$46.00

Hospital Charge Code	60635612
Hospital Revenue Code	250
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$13.80
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Oxford Commercial	$23.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$23.00

GRISEOFULVIN 125MG/5ML

Facility

$46.00

Hospital Charge Code	60635612
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

GRISEOFULVIN, MICROCRYSTALLI 250 MG TAB

Facility

$49.18

Service Code	NDC 64980018501
Hospital Charge Code	6063943202
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.38

GRISEOFULVIN, MICROCRYSTALLI 250 MG TAB

Facility

$49.18

Service Code	NDC 64980018501
Hospital Charge Code	6063943202
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$24.59
Rate for Payer: Aetna Commercial	$14.75
Rate for Payer: Aetna Medicare Advantage	$14.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.54
Rate for Payer: Cigna Commercial	$24.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.39
Rate for Payer: Oxford Commercial	$24.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.38
Rate for Payer: UnitedHealthcare Commercial	$24.59

GRISEOFULVIN TAB 330MG UMC

Facility

$10.45

Hospital Charge Code	60627247
Hospital Revenue Code	251
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

GRISEOFULVIN TAB 330MG UMC

Facility

$10.45

Hospital Charge Code	60627247
Hospital Revenue Code	251
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

GROCOTTS METH SILVER STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005272
Hospital Revenue Code	310
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$48.73
Rate for Payer: Qualcare PPO/HMO/WC	$48.73

GROCOTTS METH SILVER STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005272
Hospital Revenue Code	310
Min. Negotiated Rate	$42.23
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$97.45
Rate for Payer: Aetna Medicare Advantage	$97.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.84
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$62.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.73
Rate for Payer: UnitedHealthcare Commercial	$114.00

GROUNDING PAD

Facility

$100.00

Hospital Charge Code	270680887
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

GROUNDING PAD

Facility

$100.00

Hospital Charge Code	270680887
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$50.00

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4535607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4502607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4511607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4832607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4818607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4822607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4502607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4504607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4511607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4818607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4535607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4504607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4822607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4832607
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

Know your out-of-pocket cost for care.

All Charges