Heights University Hospital

All Charges

Charge

Type

Setting

Price

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BACITRACIN OINT PKT

Facility

$4.00

Service Code	NDC 168011109
Hospital Charge Code	60628321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACITRACIN OINT TUBE 28GM

Facility

$7.70

Hospital Charge Code	6012256
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

BACITRACIN OINT TUBE 28GM

Facility

$7.70

Hospital Charge Code	6012256
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$37.24
Max. Negotiated Rate	$37.24
Rate for Payer: Qualcare PPO/HMO/WC	$37.24

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$32.27
Max. Negotiated Rate	$124.12
Rate for Payer: Aetna Commercial	$74.47
Rate for Payer: Aetna Medicare Advantage	$74.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.30
Rate for Payer: Cigna Commercial	$124.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.27
Rate for Payer: Oxford Commercial	$124.12
Rate for Payer: Qualcare PPO/HMO/WC	$37.24
Rate for Payer: UnitedHealthcare Commercial	$124.12

BACITRACIN PACKETS

Facility

$1.00

Hospital Charge Code	60634960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

BACITRACIN PACKETS

Facility

$1.00

Hospital Charge Code	60634960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BACITRACIN POLY

Facility

$15.40

Hospital Charge Code	6008221
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

BACITRACIN POLY

Facility

$15.40

Hospital Charge Code	6008221
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$25.83
Max. Negotiated Rate	$25.83
Rate for Payer: Qualcare PPO/HMO/WC	$25.83

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$22.38
Max. Negotiated Rate	$86.09
Rate for Payer: Aetna Commercial	$51.66
Rate for Payer: Aetna Medicare Advantage	$51.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.91
Rate for Payer: Cigna Commercial	$86.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.38
Rate for Payer: Oxford Commercial	$86.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.83
Rate for Payer: UnitedHealthcare Commercial	$86.09

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$335.67
Max. Negotiated Rate	$335.67
Rate for Payer: Qualcare PPO/HMO/WC	$335.67

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$290.91
Max. Negotiated Rate	$1,118.90
Rate for Payer: Aetna Commercial	$671.34
Rate for Payer: Aetna Medicare Advantage	$671.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.64
Rate for Payer: Cigna Commercial	$1,118.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.91
Rate for Payer: Oxford Commercial	$1,118.90
Rate for Payer: Qualcare PPO/HMO/WC	$335.67
Rate for Payer: UnitedHealthcare Commercial	$1,118.90

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$69,879.51

Service Code	MSDRG 519
Min. Negotiated Rate	$21,827.35
Max. Negotiated Rate	$69,879.51
Rate for Payer: Aetna Commercial	$67,446.51
Rate for Payer: Aetna Medicare Advantage	$21,827.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,306.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,306.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,293.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,306.99
Rate for Payer: Cigna Commercial	$43,046.30
Rate for Payer: Cigna Medicare Advantage	$23,293.17
Rate for Payer: Clover Medicare Advantage	$22,128.51
Rate for Payer: EmblemHealth Commercial	$69,879.51
Rate for Payer: Humana Medicare Advantage	$23,991.97
Rate for Payer: Oxford Commercial	$26,902.69
Rate for Payer: UnitedHealthcare Commercial	$30,537.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,293.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24,690.76
Rate for Payer: Wellcare Medicare Advantage	$23,293.17

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$126,021.32

Service Code	MSDRG 518
Min. Negotiated Rate	$38,095.04
Max. Negotiated Rate	$126,021.32
Rate for Payer: Aetna Commercial	$126,021.32
Rate for Payer: Aetna Medicare Advantage	$40,783.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100,619.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100,619.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40,100.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100,619.55
Rate for Payer: Cigna Commercial	$80,430.43
Rate for Payer: Cigna Medicare Advantage	$40,100.04
Rate for Payer: Clover Medicare Advantage	$38,095.04
Rate for Payer: EmblemHealth Commercial	$120,300.12
Rate for Payer: Humana Medicare Advantage	$41,303.04
Rate for Payer: Oxford Commercial	$50,266.68
Rate for Payer: UnitedHealthcare Commercial	$57,057.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$40,100.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42,506.04
Rate for Payer: Wellcare Medicare Advantage	$40,100.04

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$55,183.77

Service Code	MSDRG 520
Min. Negotiated Rate	$16,302.31
Max. Negotiated Rate	$55,183.77
Rate for Payer: Aetna Commercial	$50,374.14
Rate for Payer: Aetna Medicare Advantage	$16,302.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,420.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,420.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,394.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,420.81
Rate for Payer: Cigna Commercial	$32,150.22
Rate for Payer: Cigna Medicare Advantage	$18,394.59
Rate for Payer: Clover Medicare Advantage	$17,474.86
Rate for Payer: EmblemHealth Commercial	$55,183.77
Rate for Payer: Humana Medicare Advantage	$18,946.43
Rate for Payer: Oxford Commercial	$20,092.96
Rate for Payer: UnitedHealthcare Commercial	$22,807.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,394.59
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19,498.27
Rate for Payer: Wellcare Medicare Advantage	$18,394.59

BACKBITER 3.4 MM

Facility

$5,712.95

Hospital Charge Code	270665785
Hospital Revenue Code	270
Min. Negotiated Rate	$856.94
Max. Negotiated Rate	$856.94
Rate for Payer: Qualcare PPO/HMO/WC	$856.94

BACKBITER 3.4 MM

Facility

$5,712.95

Hospital Charge Code	270665785
Hospital Revenue Code	270
Min. Negotiated Rate	$742.68
Max. Negotiated Rate	$2,856.47
Rate for Payer: Aetna Commercial	$1,713.88
Rate for Payer: Aetna Medicare Advantage	$1,713.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,456.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,456.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,456.80
Rate for Payer: Cigna Commercial	$2,856.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.68
Rate for Payer: Oxford Commercial	$2,856.47
Rate for Payer: Qualcare PPO/HMO/WC	$856.94
Rate for Payer: UnitedHealthcare Commercial	$2,856.47

BACK/SEAT SECTION TLT PADS

Facility

$2,528.05

Hospital Charge Code	270656356
Hospital Revenue Code	272
Min. Negotiated Rate	$328.65
Max. Negotiated Rate	$1,264.03
Rate for Payer: Aetna Commercial	$758.41
Rate for Payer: Aetna Medicare Advantage	$758.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$644.65
Rate for Payer: Cigna Commercial	$1,264.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.65
Rate for Payer: Oxford Commercial	$1,264.03
Rate for Payer: Qualcare PPO/HMO/WC	$379.21
Rate for Payer: UnitedHealthcare Commercial	$1,264.03

BACK/SEAT SECTION TLT PADS

Facility

$2,528.05

Hospital Charge Code	270656356
Hospital Revenue Code	272
Min. Negotiated Rate	$379.21
Max. Negotiated Rate	$379.21
Rate for Payer: Qualcare PPO/HMO/WC	$379.21

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$8.28
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: Aetna Medicare Advantage	$4.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.22
Rate for Payer: Cigna Commercial	$8.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$8.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.48
Rate for Payer: UnitedHealthcare Commercial	$8.28

BACLOFEN 20 MG TAB

Facility

$8.71

Service Code	NDC 63739048010
Hospital Charge Code	60627478
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$2.61
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.13
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$4.36

Know your out-of-pocket cost for care.

All Charges