Heights University Hospital

All Charges

Charge

Type

Setting

Price

BEHAV CHNG SMOKING > 10 MIN

Facility

$2,700.00

Service Code	HCPCS 99407
Hospital Charge Code	395099407
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	412399406
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	395099406
Hospital Revenue Code	942
Min. Negotiated Rate	$89.22
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	412399406
Hospital Revenue Code	942
Min. Negotiated Rate	$89.22
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$779.00

BEHAV CHNG SMOKING 3-10 MIN

Facility

$2,700.00

Service Code	HCPCS 99406
Hospital Charge Code	395099406
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$72,059.34

Service Code	MSDRG 886
Min. Negotiated Rate	$22,646.88
Max. Negotiated Rate	$72,059.34
Rate for Payer: Aetna Commercial	$69,978.86
Rate for Payer: Aetna Medicare Advantage	$22,646.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,312.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,312.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,019.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,312.56
Rate for Payer: Cigna Commercial	$44,662.53
Rate for Payer: Cigna Medicare Advantage	$24,019.78
Rate for Payer: Clover Medicare Advantage	$22,818.79
Rate for Payer: EmblemHealth Commercial	$72,059.34
Rate for Payer: Humana Medicare Advantage	$24,740.37
Rate for Payer: Oxford Commercial	$27,912.78
Rate for Payer: UnitedHealthcare Commercial	$31,683.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,019.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,460.97
Rate for Payer: Wellcare Medicare Advantage	$24,019.78

BELLADONNA&OPIUM SUPP

Facility

$15.00

Hospital Charge Code	60635582
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

BELLADONNA&OPIUM SUPP

Facility

$15.00

Hospital Charge Code	60635582
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

BELLADONNA PHENOBAR 16MG 4 OZ

Facility

$3.85

Hospital Charge Code	6000566
Hospital Revenue Code	251
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

BELLADONNA PHENOBAR 16MG 4 OZ

Facility

$3.85

Hospital Charge Code	6000566
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

BELLADONNA-PHENOBARBITAL TAB

Facility

$62.51

Service Code	NDC 42291024501
Hospital Charge Code	60627427
Hospital Revenue Code	251
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$18.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.13
Rate for Payer: Oxford Commercial	$31.25
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$31.25

BELLADONNA-PHENOBARBITAL TAB

Facility

$62.51

Service Code	NDC 42291024501
Hospital Charge Code	60627427
Hospital Revenue Code	251
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

BELLERGAL-S/TAB

Facility

$6.00

Hospital Charge Code	60632538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

BELLERGAL-S/TAB

Facility

$6.00

Hospital Charge Code	60632538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

BELT MONIT PINK & BLUE

Facility

$9.65

Hospital Charge Code	270600598
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

BELT MONIT PINK & BLUE

Facility

$9.65

Hospital Charge Code	270600598
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

BELT OSTOMY LG 29-49

Facility

$24.46

Hospital Charge Code	270649979
Hospital Revenue Code	272
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare Advantage	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.24
Rate for Payer: Cigna Commercial	$12.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.18
Rate for Payer: Oxford Commercial	$12.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.67
Rate for Payer: UnitedHealthcare Commercial	$12.23

BELT OSTOMY LG 29-49

Facility

$24.46

Hospital Charge Code	270649979
Hospital Revenue Code	272
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$3.67

BELT PELVIC EXTRA****

Facility

$253.00

Hospital Charge Code	8001968
Hospital Revenue Code	279
Min. Negotiated Rate	$32.89
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$75.90
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.89
Rate for Payer: Oxford Commercial	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$126.50

BELT PELVIC EXTRA****

Facility

$253.00

Hospital Charge Code	8001968
Hospital Revenue Code	279
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

BELT PELVIC TRACTIN ZIMCODE

Facility

$86.80

Hospital Charge Code	270654048
Hospital Revenue Code	270
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.02

BELT PELVIC TRACTIN ZIMCODE

Facility

$86.80

Hospital Charge Code	270654048
Hospital Revenue Code	270
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$43.40
Rate for Payer: Aetna Commercial	$26.04
Rate for Payer: Aetna Medicare Advantage	$26.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.13
Rate for Payer: Cigna Commercial	$43.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.28
Rate for Payer: Oxford Commercial	$43.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.02
Rate for Payer: UnitedHealthcare Commercial	$43.40

BELT PELVIC TRACTION 1570-01

Facility

$150.45

Hospital Charge Code	270302700
Hospital Revenue Code	270
Min. Negotiated Rate	$19.56
Max. Negotiated Rate	$75.22
Rate for Payer: Aetna Commercial	$45.13
Rate for Payer: Aetna Medicare Advantage	$45.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.36
Rate for Payer: Cigna Commercial	$75.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.56
Rate for Payer: Oxford Commercial	$75.22
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$75.22

BELT PELVIC TRACTION 1570-01

Facility

$150.45

Hospital Charge Code	270302700
Hospital Revenue Code	270
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

BELT PELVIC TRACTION 30/34

Facility

$101.50

Hospital Charge Code	270650450
Hospital Revenue Code	272
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$50.75
Rate for Payer: Aetna Commercial	$30.45
Rate for Payer: Aetna Medicare Advantage	$30.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.88
Rate for Payer: Cigna Commercial	$50.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$50.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.22
Rate for Payer: UnitedHealthcare Commercial	$50.75

Know your out-of-pocket cost for care.

All Charges