Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYDROPES-25/TAB

Facility

$3.00

Hospital Charge Code	60634380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROPES-25/TAB

Facility

$3.00

Hospital Charge Code	60634380
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

HYDROPHILIC OINT 52GM

Facility

$29.35

Hospital Charge Code	606350911
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

HYDROPHILIC OINT 52GM

Facility

$29.35

Hospital Charge Code	606350911
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna Commercial	$8.80
Rate for Payer: Aetna Medicare Advantage	$8.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.48
Rate for Payer: Cigna Commercial	$14.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.82
Rate for Payer: Oxford Commercial	$14.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$14.68

HYDROPOL DRESS 5 7/8 X 7 3/4

Facility

$82.00

Hospital Charge Code	9808250
Hospital Revenue Code	272
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$41.00

HYDROPOL DRESS 5 7/8 X 7 3/4

Facility

$82.00

Hospital Charge Code	9808250
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

HYDROPRES-50/TAB

Facility

$3.00

Hospital Charge Code	60633124
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROPRES-50/TAB

Facility

$3.00

Hospital Charge Code	60633124
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

HYDROSCOPIC HUMIDIFIER ADULT

Facility

$9.50

Hospital Charge Code	270655463
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.42
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.75

HYDROSCOPIC HUMIDIFIER ADULT

Facility

$9.50

Hospital Charge Code	270655463
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$1,950.31
Max. Negotiated Rate	$7,501.18
Rate for Payer: Aetna Commercial	$4,500.70
Rate for Payer: Aetna Medicare Advantage	$4,500.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.60
Rate for Payer: Cigna Commercial	$7,501.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,950.31
Rate for Payer: Oxford Commercial	$7,501.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35
Rate for Payer: UnitedHealthcare Commercial	$7,501.18

HYDROSET

Facility

$22,500.00

Hospital Charge Code	270656507
Hospital Revenue Code	272
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$3,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

HYDROSET

Facility

$22,500.00

Hospital Charge Code	270656507
Hospital Revenue Code	272
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$6,750.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,925.00
Rate for Payer: Oxford Commercial	$11,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Commercial	$11,250.00

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$2,250.35
Max. Negotiated Rate	$2,250.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.59
Max. Negotiated Rate	$1,888.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.59
Max. Negotiated Rate	$3,901.95
Rate for Payer: Aetna Commercial	$2,341.17
Rate for Payer: Aetna Medicare Advantage	$2,341.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.99
Rate for Payer: Cigna Commercial	$3,901.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,954.50
Max. Negotiated Rate	$6,515.00
Rate for Payer: Aetna Commercial	$3,909.00
Rate for Payer: Aetna Medicare Advantage	$3,909.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,322.65
Rate for Payer: Cigna Commercial	$6,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,954.50

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,954.50
Max. Negotiated Rate	$3,153.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,954.50

HYDROSORB MEDT 8 26 092005

Facility

$15,813.65

Hospital Charge Code	270629193
Hospital Revenue Code	272
Min. Negotiated Rate	$2,055.77
Max. Negotiated Rate	$7,906.82
Rate for Payer: Aetna Commercial	$4,744.10
Rate for Payer: Aetna Medicare Advantage	$4,744.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,032.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,032.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,032.48
Rate for Payer: Cigna Commercial	$7,906.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,055.77
Rate for Payer: Oxford Commercial	$7,906.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,372.05
Rate for Payer: UnitedHealthcare Commercial	$7,906.82

HYDROSORB MEDT 8 26 092005

Facility

$15,813.65

Hospital Charge Code	270629193
Hospital Revenue Code	272
Min. Negotiated Rate	$2,372.05
Max. Negotiated Rate	$2,372.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,372.05

HYDROX 24

Facility

$1,002.00

Service Code	HCPCS 83500
Hospital Charge Code	3000369B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$150.30
Rate for Payer: Aetna Medicare Advantage	$22.65
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.99
Rate for Payer: Cigna Commercial	$22.65
Rate for Payer: Cigna Medicare Advantage	$11.32
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.01
Rate for Payer: Wellcare Medicare Advantage	$22.65

HYDROX 24

Facility

$107.00

Service Code	HCPCS 82570
Hospital Charge Code	3000369A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

HYDROX 24

Facility

$1,002.00

Service Code	HCPCS 83500
Hospital Charge Code	3000369B
Hospital Revenue Code	301
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$150.30
Rate for Payer: Qualcare PPO/HMO/WC	$150.30

HYDROX 24

Facility

$107.00

Service Code	HCPCS 82570
Hospital Charge Code	3000369A
Hospital Revenue Code	301
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	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
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

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

Know your out-of-pocket cost for care.

All Charges