Heights University Hospital

All Charges

Charge

Type

Setting

Price

OFF VISIT NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$133.80
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
Hospital Revenue Code	510
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OFF VISIT NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84505020
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84505020
Hospital Revenue Code	510
Min. Negotiated Rate	$136.36
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$314.68
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$19,183.08
Rate for Payer: Aetna Medicare Advantage	$19,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,305.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,305.62
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	$16,305.62
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,312.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$64.45
Max. Negotiated Rate	$247.90
Rate for Payer: Aetna Commercial	$148.74
Rate for Payer: Aetna Medicare Advantage	$148.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.43
Rate for Payer: Cigna Commercial	$247.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.45
Rate for Payer: Oxford Commercial	$247.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.37
Rate for Payer: UnitedHealthcare Commercial	$247.90

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$74.37
Max. Negotiated Rate	$74.37
Rate for Payer: Qualcare PPO/HMO/WC	$74.37

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$21.05

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$70.15
Rate for Payer: Aetna Commercial	$42.09
Rate for Payer: Aetna Medicare Advantage	$42.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.78
Rate for Payer: Cigna Commercial	$70.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.24
Rate for Payer: Oxford Commercial	$70.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.05
Rate for Payer: UnitedHealthcare Commercial	$70.15

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

OIL CARTRIDGE MAESTRO

Facility

$103.50

Hospital Charge Code	270672676
Hospital Revenue Code	272
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Commercial	$31.05
Rate for Payer: Aetna Medicare Advantage	$31.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$51.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.46
Rate for Payer: Oxford Commercial	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$51.75

OIL RED O STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005302
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

OIL RED O STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005302
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$7.67
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Aetna Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.91
Rate for Payer: Cigna Commercial	$7.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.99
Rate for Payer: Oxford Commercial	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.30
Rate for Payer: UnitedHealthcare Commercial	$7.67

OINTMENT ANTIFUNGAL 2oz

Facility

$15.33

Hospital Charge Code	270651551
Hospital Revenue Code	270
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.30

OINTMENT BASE 454GM

Facility

$41.60

Hospital Charge Code	6004006
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

OINTMENT BASE 454GM

Facility

$41.60

Hospital Charge Code	6004006
Hospital Revenue Code	251
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

OINTMENT HEMORROHOIDAL

Facility

$4.00

Service Code	NDC 45802018816
Hospital Charge Code	60630001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OINTMENT HEMORROHOIDAL

Facility

$4.00

Service Code	NDC 45802018816
Hospital Charge Code	60630001
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

OK TO USE

Facility

$620.00

Hospital Charge Code	270634621
Hospital Revenue Code	278
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.04
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

Know your out-of-pocket cost for care.

All Charges