Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$28,194.34

Service Code	APR-DRG 0493
Min. Negotiated Rate	$24,167.03
Max. Negotiated Rate	$28,194.34
Rate for Payer: Aetna Better Health Medicaid	$27,641.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,194.34
Rate for Payer: Wellpoint Medicaid Managed Care	$24,167.03

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$46,365.62

Service Code	APR-DRG 0494
Min. Negotiated Rate	$44,460.49
Max. Negotiated Rate	$46,365.62
Rate for Payer: Aetna Better Health Medicaid	$45,456.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,365.62
Rate for Payer: Wellpoint Medicaid Managed Care	$44,460.49

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$11,933.02

Service Code	APR-DRG 0491
Min. Negotiated Rate	$8,914.35
Max. Negotiated Rate	$11,933.02
Rate for Payer: Aetna Better Health Medicaid	$11,699.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,933.02
Rate for Payer: Wellpoint Medicaid Managed Care	$8,914.35

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$25,417.90

Service Code	APR-DRG 0492
Min. Negotiated Rate	$19,487.62
Max. Negotiated Rate	$25,417.90
Rate for Payer: Aetna Better Health Medicaid	$24,919.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,417.90
Rate for Payer: Wellpoint Medicaid Managed Care	$19,487.62

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$86,970.31

Service Code	MSDRG 095
Min. Negotiated Rate	$27,450.38
Max. Negotiated Rate	$86,970.31
Rate for Payer: Aetna Commercial	$86,970.31
Rate for Payer: Aetna Medicare Advantage	$28,145.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65,609.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65,609.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,895.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65,609.46
Rate for Payer: Cigna Medicare Advantage	$28,895.14
Rate for Payer: Clover Medicare Advantage	$27,450.38
Rate for Payer: EmblemHealth Commercial	$86,685.42
Rate for Payer: Humana Medicare Advantage	$29,761.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,895.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$30,628.85
Rate for Payer: Wellcare Medicare Advantage	$28,895.14

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$118,673.74

Service Code	MSDRG 094
Min. Negotiated Rate	$36,092.21
Max. Negotiated Rate	$118,673.74
Rate for Payer: Aetna Commercial	$118,673.74
Rate for Payer: Aetna Medicare Advantage	$38,405.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99,792.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99,792.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37,991.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99,792.54
Rate for Payer: Cigna Medicare Advantage	$37,991.80
Rate for Payer: Clover Medicare Advantage	$36,092.21
Rate for Payer: EmblemHealth Commercial	$113,975.40
Rate for Payer: Humana Medicare Advantage	$39,131.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$37,991.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$40,271.31
Rate for Payer: Wellcare Medicare Advantage	$37,991.80

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$86,970.31

Service Code	MSDRG 096
Min. Negotiated Rate	$27,450.38
Max. Negotiated Rate	$86,970.31
Rate for Payer: Aetna Commercial	$86,970.31
Rate for Payer: Aetna Medicare Advantage	$28,145.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,096.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,096.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,895.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,096.06
Rate for Payer: Cigna Medicare Advantage	$28,895.14
Rate for Payer: Clover Medicare Advantage	$27,450.38
Rate for Payer: EmblemHealth Commercial	$86,685.42
Rate for Payer: Humana Medicare Advantage	$29,761.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,895.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$30,628.85
Rate for Payer: Wellcare Medicare Advantage	$28,895.14

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.25
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.64
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: Cigna Medicare Advantage	$6.37
Rate for Payer: Clover Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Humana Medicare Advantage	$13.11
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	$12.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.49
Rate for Payer: Wellcare Medicare Advantage	$12.73

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
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	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
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	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
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	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

BACTERIAL ANTIGENS ALL SOURCES

Facility

$114.00

Service Code	HCPCS 87802
Hospital Charge Code	3006526A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.25
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.64
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: Cigna Medicare Advantage	$6.37
Rate for Payer: Clover Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Humana Medicare Advantage	$13.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.49
Rate for Payer: Wellcare Medicare Advantage	$12.73

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526C
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526D
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526B
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526C
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526D
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

BACTERIAL ANTIGENS ALL SOURCES

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3006526B
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

Know your out-of-pocket cost for care.

All Charges