Heights University Hospital

All Charges

Charge

Type

Setting

Price

HETASTARCH 6% 500ML

Facility

$270.00

Hospital Charge Code	60635247
Hospital Revenue Code	250
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

HETASTARCH INJ 30GM/500ML NACL

Facility

$515.20

Hospital Charge Code	6002760
Hospital Revenue Code	250
Min. Negotiated Rate	$66.98
Max. Negotiated Rate	$257.60
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$257.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.98
Rate for Payer: Oxford Commercial	$257.60
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$257.60

HETASTARCH INJ 30GM/500ML NACL

Facility

$515.20

Hospital Charge Code	6002760
Hospital Revenue Code	250
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

HETASTARCH/SODM CHOL 500ML SOL

Facility

$75.00

Hospital Charge Code	60629100
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

HETASTARCH/SODM CHOL 500ML SOL

Facility

$75.00

Hospital Charge Code	60629100
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

HETEROPHILE MONOSPOT

Facility

$390.00

Service Code	HCPCS 86308
Hospital Charge Code	39900511
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HETEROPHILE MONOSPOT

Facility

$390.00

Service Code	HCPCS 86308
Hospital Charge Code	39900511
Hospital Revenue Code	302
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
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	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

HETEROPHILE,SCREEN

Facility

$297.00

Service Code	HCPCS 86308
Hospital Charge Code	38476015
Hospital Revenue Code	302
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

HETEROPHILE,SCREEN

Facility

$297.00

Service Code	HCPCS 86308
Hospital Charge Code	38476015
Hospital Revenue Code	302
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$44.55

HETEROPHILE,TITER

Facility

$273.00

Service Code	HCPCS 86309
Hospital Charge Code	38476018
Hospital Revenue Code	302
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

HETEROPHILE,TITER

Facility

$273.00

Service Code	HCPCS 86309
Hospital Charge Code	38476018
Hospital Revenue Code	302
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

HEXA-BETALIN/100MG/1ML

Facility

$17.00

Hospital Charge Code	60633090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.50

HEXA-BETALIN/100MG/1ML

Facility

$17.00

Hospital Charge Code	60633090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

HEXACHLOROPHENE 3% 150ML

Facility

$54.45

Hospital Charge Code	6009641
Hospital Revenue Code	251
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$27.23
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.88
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.08
Rate for Payer: Oxford Commercial	$27.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$27.23

HEXACHLOROPHENE 3% 150ML

Facility

$54.45

Hospital Charge Code	6009641
Hospital Revenue Code	251
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

HEXACHLOROPHENE 3% SOAP 473ML

Facility

$225.00

Hospital Charge Code	60628350
Hospital Revenue Code	250
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$112.50

HEXACHLOROPHENE 3% SOAP 473ML

Facility

$225.00

Hospital Charge Code	60628350
Hospital Revenue Code	250
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

HEXACHLOROPHENE SOL 148ML

Facility

$61.45

Hospital Charge Code	6015010
Hospital Revenue Code	251
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

HEXACHLOROPHENE SOL 148ML

Facility

$61.45

Hospital Charge Code	6015010
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

HEXADROL/0.5MG/5ML

Facility

$8.00

Hospital Charge Code	60633091
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

HEXADROL/0.5MG/5ML

Facility

$8.00

Hospital Charge Code	60633091
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

HEXADROL/6MG/TAB/U/D

Facility

$3.00

Hospital Charge Code	60634798
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

HEXADROL/6MG/TAB/U/D

Facility

$3.00

Hospital Charge Code	60634798
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HEXAGONAL PHASE PHOSPHOLIPID

Facility

$123.55

Service Code	HCPCS 85598
Hospital Charge Code	3038097
Hospital Revenue Code	300
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

HEXAGONAL PHASE PHOSPHOLIPID

Facility

$123.55

Service Code	HCPCS 85598
Hospital Charge Code	3038097
Hospital Revenue Code	300
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$18.53
Rate for Payer: Qualcare PPO/HMO/WC	$18.53

Know your out-of-pocket cost for care.

All Charges