Heights University Hospital

All Charges

Charge

Type

Setting

Price

AUGMENTIN 125/125MG/5ML

Facility

$61.00

Hospital Charge Code	60632510
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

AUGMENTIN 125/125MG/5ML

Facility

$61.00

Hospital Charge Code	60632510
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

AUGMENTIN 200MG/5ML

Facility

$4.00

Service Code	NDC 43598021352
Hospital Charge Code	6063943289
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AUGMENTIN 200MG/5ML

Facility

$4.00

Service Code	NDC 43598021352
Hospital Charge Code	6063943289
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

AUGMENTIN 250/250MG/5ML

Facility

$172.00

Hospital Charge Code	60632512
Hospital Revenue Code	250
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$51.60
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.36
Rate for Payer: Oxford Commercial	$86.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$86.00

AUGMENTIN 250/250MG/5ML

Facility

$138.00

Hospital Charge Code	60632513
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

AUGMENTIN 250/250MG/5ML

Facility

$138.00

Hospital Charge Code	60632513
Hospital Revenue Code	250
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$41.40
Rate for Payer: Aetna Medicare Advantage	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.19
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.94
Rate for Payer: Oxford Commercial	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Commercial	$69.00

AUGMENTIN 250/250MG/5ML

Facility

$172.00

Hospital Charge Code	60632512
Hospital Revenue Code	250
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

AUGMENTIN 250/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

AUGMENTIN 250/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

AUGMENTIN 500/500MG/TAB

Facility

$9.00

Hospital Charge Code	60632514
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

AUGMENTIN 500/500MG/TAB

Facility

$9.00

Hospital Charge Code	60632514
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

AURALGAN

Facility

$66.00

Hospital Charge Code	60634515
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

AURALGAN

Facility

$66.00

Hospital Charge Code	60634515
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

AUROTHIOGLUC INJ 50MG/1ML 10ML

Facility

$146.25

Hospital Charge Code	60628175
Hospital Revenue Code	250
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$73.12
Rate for Payer: Aetna Commercial	$43.88
Rate for Payer: Aetna Medicare Advantage	$43.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.29
Rate for Payer: Cigna Commercial	$73.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.01
Rate for Payer: Oxford Commercial	$73.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.94
Rate for Payer: UnitedHealthcare Commercial	$73.12

AUROTHIOGLUC INJ 50MG/1ML 10ML

Facility

$146.25

Hospital Charge Code	60628175
Hospital Revenue Code	250
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$21.94
Rate for Payer: Qualcare PPO/HMO/WC	$21.94

AUROTHIOGLUC INJ 50MG/ML

Facility

$114.00

Hospital Charge Code	6000509
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Commercial	$57.00

AUROTHIOGLUC INJ 50MG/ML

Facility

$114.00

Hospital Charge Code	6000509
Hospital Revenue Code	250
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

AUTGRFT IMPLNT KNEE W/SCOPE

Facility

$28,042.44

Service Code	HCPCS 29866
Hospital Charge Code	16000729
Hospital Revenue Code	360
Min. Negotiated Rate	$4,206.37
Max. Negotiated Rate	$4,206.37
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37

AUTGRFT IMPLNT KNEE W/SCOPE

Facility

$28,042.44

Service Code	HCPCS 29866
Hospital Charge Code	16000729
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$8,412.73
Rate for Payer: Aetna Medicare Advantage	$8,412.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,150.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,150.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,150.82
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,645.52
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

AUTH FOR DEVIA/STAND BB PROC

Facility

$207.25

Service Code	HCPCS 86079
Hospital Charge Code	3108008
Hospital Revenue Code	302
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

AUTH FOR DEVIA/STAND BB PROC

Facility

$207.25

Service Code	HCPCS 86079
Hospital Charge Code	3108008
Hospital Revenue Code	302
Min. Negotiated Rate	$21.29
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$62.17
Rate for Payer: Aetna Medicare Advantage	$62.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$21.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTO BLOOD PROCESSING&STORAGE

Facility

$405.00

Service Code	HCPCS 86890
Hospital Charge Code	38470103
Hospital Revenue Code	309
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

AUTO BLOOD PROCESSING&STORAGE

Facility

$405.00

Service Code	HCPCS 86890
Hospital Charge Code	38470103
Hospital Revenue Code	309
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

AUTOCHONDROCYTE IMPLANT KNEE

Facility

$22,425.68

Service Code	HCPCS 27412
Hospital Charge Code	16000885
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$6,727.70
Rate for Payer: Aetna Medicare Advantage	$6,727.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,718.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,718.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,718.55
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.34
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges