Heights University Hospital

All Charges

Charge

Type

Setting

Price

BACTROBAN,2% CREAM

Facility

$37.00

Hospital Charge Code	60635453
Hospital Revenue Code	250
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.81
Rate for Payer: Oxford Commercial	$18.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$18.50

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$32.63
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$75.30
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.63
Rate for Payer: Oxford Commercial	$125.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$125.50

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
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

BAER EVOKED POTENTIAL AUDITORY

Facility

$672.00

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,180.00
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	$336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

BAER EVOKED POTENTIAL AUDITORY

Facility

$672.00

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$810.60
Rate for Payer: Cigna Medicare Advantage	$486.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$810.60
Rate for Payer: Cigna Medicare Advantage	$486.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAG 605697*****

Facility

$40.20

Hospital Charge Code	270605697
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

BAG 605697*****

Facility

$40.20

Hospital Charge Code	270605697
Hospital Revenue Code	272
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$12.06
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$20.10

BAG AEROSOL DRAINAGE WYE ADAPT

Facility

$223.85

Hospital Charge Code	270651477
Hospital Revenue Code	270
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$111.92
Rate for Payer: Aetna Commercial	$67.16
Rate for Payer: Aetna Medicare Advantage	$67.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.08
Rate for Payer: Cigna Commercial	$111.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$111.92
Rate for Payer: Qualcare PPO/HMO/WC	$33.58
Rate for Payer: UnitedHealthcare Commercial	$111.92

BAG AEROSOL DRAINAGE WYE ADAPT

Facility

$223.85

Hospital Charge Code	270651477
Hospital Revenue Code	270
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$33.58
Rate for Payer: Qualcare PPO/HMO/WC	$33.58

BAG-A-JET

Facility

$3.70

Hospital Charge Code	270060055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna Commercial	$1.11
Rate for Payer: Aetna Medicare Advantage	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.94
Rate for Payer: Cigna Commercial	$1.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.48
Rate for Payer: Oxford Commercial	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$1.85

BAG-A-JET

Facility

$3.70

Hospital Charge Code	270060055
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

BAG ALCON SURGICAL ******

Facility

$46.00

Hospital Charge Code	1608215
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$13.80
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Oxford Commercial	$23.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$23.00

BAG ALCON SURGICAL ******

Facility

$46.00

Hospital Charge Code	1608215
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

BAG AMBU INFANT

Facility

$47.73

Hospital Charge Code	270651479
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$23.86
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: Aetna Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.17
Rate for Payer: Cigna Commercial	$23.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.20
Rate for Payer: Oxford Commercial	$23.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.16
Rate for Payer: UnitedHealthcare Commercial	$23.86

BAG AMBU INFANT

Facility

$47.73

Hospital Charge Code	270651479
Hospital Revenue Code	270
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.16

BAG AMBU INFANT SPUR II

Facility

$134.13

Hospital Charge Code	270647279
Hospital Revenue Code	270
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$20.12
Rate for Payer: Qualcare PPO/HMO/WC	$20.12

BAG AMBU INFANT SPUR II

Facility

$134.13

Hospital Charge Code	270647279
Hospital Revenue Code	270
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$67.06
Rate for Payer: Aetna Commercial	$40.24
Rate for Payer: Aetna Medicare Advantage	$40.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.20
Rate for Payer: Cigna Commercial	$67.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.44
Rate for Payer: Oxford Commercial	$67.06
Rate for Payer: Qualcare PPO/HMO/WC	$20.12
Rate for Payer: UnitedHealthcare Commercial	$67.06

BAG AMBU RESUSCITATOR DISP

Facility

$37.88

Hospital Charge Code	270650265
Hospital Revenue Code	272
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$18.94
Rate for Payer: Aetna Commercial	$11.36
Rate for Payer: Aetna Medicare Advantage	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.66
Rate for Payer: Cigna Commercial	$18.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.92
Rate for Payer: Oxford Commercial	$18.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.68
Rate for Payer: UnitedHealthcare Commercial	$18.94

BAG AMBU RESUSCITATOR DISP

Facility

$37.88

Hospital Charge Code	270650265
Hospital Revenue Code	272
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.68

Know your out-of-pocket cost for care.

All Charges