Heights University Hospital

All Charges

Charge

Type

Setting

Price

NOVOLOG 70/30 PEN

Facility

$2,472.50

Hospital Charge Code	6063943152
Hospital Revenue Code	250
Min. Negotiated Rate	$370.88
Max. Negotiated Rate	$370.88
Rate for Payer: Qualcare PPO/HMO/WC	$370.88

NOVOLOG 70/30 PEN

Facility

$2,472.50

Hospital Charge Code	6063943152
Hospital Revenue Code	250
Min. Negotiated Rate	$321.43
Max. Negotiated Rate	$1,236.25
Rate for Payer: Aetna Commercial	$741.75
Rate for Payer: Aetna Medicare Advantage	$741.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.49
Rate for Payer: Cigna Commercial	$1,236.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.43
Rate for Payer: Oxford Commercial	$1,236.25
Rate for Payer: Qualcare PPO/HMO/WC	$370.88
Rate for Payer: UnitedHealthcare Commercial	$1,236.25

NOVOLOG MIX 70/30

Facility

$4.00

Service Code	NDC 169368512
Hospital Charge Code	60635483
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

NOVOLOG MIX 70/30

Facility

$4.00

Service Code	NDC 169368512
Hospital Charge Code	60635483
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NOVOLOG PEN

Facility

$2,472.40

Hospital Charge Code	6063943153
Hospital Revenue Code	250
Min. Negotiated Rate	$321.41
Max. Negotiated Rate	$1,236.20
Rate for Payer: Aetna Commercial	$741.72
Rate for Payer: Aetna Medicare Advantage	$741.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.46
Rate for Payer: Cigna Commercial	$1,236.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.41
Rate for Payer: Oxford Commercial	$1,236.20
Rate for Payer: Qualcare PPO/HMO/WC	$370.86
Rate for Payer: UnitedHealthcare Commercial	$1,236.20

NOVOLOG PEN

Facility

$2,472.40

Hospital Charge Code	6063943153
Hospital Revenue Code	250
Min. Negotiated Rate	$370.86
Max. Negotiated Rate	$370.86
Rate for Payer: Qualcare PPO/HMO/WC	$370.86

NOVOSTITCH CARTIDGE 0

Facility

$2,375.00

Hospital Charge Code	270688717
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

NOVOSTITCH CARTIDGE 0

Facility

$2,375.00

Hospital Charge Code	270688717
Hospital Revenue Code	272
Min. Negotiated Rate	$308.75
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$1,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$1,187.50

NOVOSTIT PRO MENISAL RPR SYS 0

Facility

$2,475.00

Hospital Charge Code	270688718
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

NOVOSTIT PRO MENISAL RPR SYS 0

Facility

$2,475.00

Hospital Charge Code	270688718
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.75
Rate for Payer: Oxford Commercial	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$1,237.50

NPH (U100)

Facility

$10.90

Hospital Charge Code	6008353
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

NPH (U100)

Facility

$10.90

Hospital Charge Code	6008353
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

NPLATE 250MCG

Facility

$5,850.00

Hospital Charge Code	60635713
Hospital Revenue Code	250
Min. Negotiated Rate	$760.50
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$1,755.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$760.50
Rate for Payer: Oxford Commercial	$2,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50
Rate for Payer: UnitedHealthcare Commercial	$2,925.00

NPLATE 250MCG

Facility

$5,850.00

Hospital Charge Code	60635713
Hospital Revenue Code	250
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$877.50
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

NPWT < 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97607
Hospital Charge Code	9808331
Hospital Revenue Code	361
Min. Negotiated Rate	$112.78
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$260.26
Rate for Payer: Aetna Medicare Advantage	$260.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.22
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	$221.22
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.78
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT < 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97607
Hospital Charge Code	9808331
Hospital Revenue Code	361
Min. Negotiated Rate	$130.13
Max. Negotiated Rate	$130.13
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT > 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97608
Hospital Charge Code	9808332
Hospital Revenue Code	361
Min. Negotiated Rate	$112.78
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$260.26
Rate for Payer: Aetna Medicare Advantage	$260.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.22
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	$221.22
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.78
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT > 50 SQ CM WO DME

Facility

$867.53

Service Code	HCPCS 97608
Hospital Charge Code	9808332
Hospital Revenue Code	361
Min. Negotiated Rate	$130.13
Max. Negotiated Rate	$130.13
Rate for Payer: Qualcare PPO/HMO/WC	$130.13

NPWT TWO DRESSING KIT 10X20CM

Facility

$572.00

Hospital Charge Code	270693967
Hospital Revenue Code	270
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$85.80

NPWT TWO DRESSING KIT 10X20CM

Facility

$572.00

Hospital Charge Code	270693967
Hospital Revenue Code	270
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$286.00
Rate for Payer: Aetna Commercial	$171.60
Rate for Payer: Aetna Medicare Advantage	$171.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.86
Rate for Payer: Cigna Commercial	$286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.36
Rate for Payer: Oxford Commercial	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.80
Rate for Payer: UnitedHealthcare Commercial	$286.00

NPWT TWO DRESSING KIT 10X40CM

Facility

$572.83

Hospital Charge Code	270693968
Hospital Revenue Code	270
Min. Negotiated Rate	$85.92
Max. Negotiated Rate	$85.92
Rate for Payer: Qualcare PPO/HMO/WC	$85.92

NPWT TWO DRESSING KIT 10X40CM

Facility

$572.83

Hospital Charge Code	270693968
Hospital Revenue Code	270
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$286.42
Rate for Payer: Aetna Commercial	$171.85
Rate for Payer: Aetna Medicare Advantage	$171.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.07
Rate for Payer: Cigna Commercial	$286.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.47
Rate for Payer: Oxford Commercial	$286.42
Rate for Payer: Qualcare PPO/HMO/WC	$85.92
Rate for Payer: UnitedHealthcare Commercial	$286.42

NSL/SINS NDSC TOTAL

Facility

$31,659.60

Service Code	HCPCS 31253
Hospital Charge Code	1600000467
Hospital Revenue Code	360
Min. Negotiated Rate	$4,748.94
Max. Negotiated Rate	$4,748.94
Rate for Payer: Qualcare PPO/HMO/WC	$4,748.94

NSL/SINS NDSC TOTAL

Facility

$31,659.60

Service Code	HCPCS 31253
Hospital Charge Code	1600000467
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$16,806.60
Rate for Payer: Aetna Commercial	$9,497.88
Rate for Payer: Aetna Medicare Advantage	$9,497.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,073.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,073.20
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	$8,073.20
Rate for Payer: Cigna Commercial	$16,806.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,115.75
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,748.94
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

NSL/SINS NDSC TOT W/SPHENDT

Facility

$31,659.60

Service Code	HCPCS 31257
Hospital Charge Code	1600000466
Hospital Revenue Code	360
Min. Negotiated Rate	$4,748.94
Max. Negotiated Rate	$4,748.94
Rate for Payer: Qualcare PPO/HMO/WC	$4,748.94

Know your out-of-pocket cost for care.

All Charges