Heights University Hospital

All Charges

Charge

Type

Setting

Price

BETADINE SINGLES BOX*****

Facility

$168.00

Hospital Charge Code	8000242
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

BETADINE SINGLES BOX*****

Facility

$168.00

Hospital Charge Code	8000242
Hospital Revenue Code	279
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$84.00

BETADINE SLN 4OZBTL 6761815004

Facility

$5.40

Hospital Charge Code	270643110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna Commercial	$1.62
Rate for Payer: Aetna Medicare Advantage	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.70

BETADINE SLN 4OZBTL 6761815004

Facility

$5.40

Hospital Charge Code	270643110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

BETADINE SOLUTION GAL.

Facility

$64.00

Hospital Charge Code	270331184
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

BETADINE SOLUTION GAL.

Facility

$64.00

Hospital Charge Code	270331184
Hospital Revenue Code	272
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

BETADINE SURG SCRUB GAL

Facility

$115.00

Hospital Charge Code	270331188
Hospital Revenue Code	272
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

BETADINE SURG SCRUB GAL

Facility

$115.00

Hospital Charge Code	270331188
Hospital Revenue Code	272
Min. Negotiated Rate	$14.95
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.95
Rate for Payer: Oxford Commercial	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$57.50

BETADINE SWABSTICKS/EACH

Facility

$3.00

Hospital Charge Code	60632546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

BETADINE SWABSTICKS/EACH

Facility

$3.00

Hospital Charge Code	60632546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETA GALACTOSIDASE ACTIVITY***

Facility

$324.00

Service Code	HCPCS 84999
Hospital Charge Code	3009826
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

BETA GALACTOSIDASE ACTIVITY***

Facility

$324.00

Service Code	HCPCS 84999
Hospital Charge Code	3009826
Hospital Revenue Code	301
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

BETA GALACTOSIDASE DEFICIANCY

Facility

$110.00

Hospital Charge Code	3000600
Hospital Revenue Code	301
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

BETA GALACTOSIDASE DEFICIANCY

Facility

$110.00

Hospital Charge Code	3000600
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

BETA GALACTOSIDASE DEFICIENCY

Facility

$110.00

Service Code	HCPCS 82657
Hospital Charge Code	3007215
Hospital Revenue Code	301
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$71.83
Rate for Payer: Aetna Medicare Advantage	$22.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.23
Rate for Payer: Cigna Commercial	$22.17
Rate for Payer: Cigna Medicare Advantage	$11.09
Rate for Payer: Clover Medicare Advantage	$21.06
Rate for Payer: EmblemHealth Commercial	$66.51
Rate for Payer: Humana Medicare Advantage	$22.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.50
Rate for Payer: Wellcare Medicare Advantage	$22.17

BETA GALACTOSIDASE DEFICIENCY

Facility

$110.00

Service Code	HCPCS 82657
Hospital Charge Code	3007215
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

BETAGAN 0.25% OPHTH/5ML

Facility

$164.69

Service Code	NDC 23438505
Hospital Charge Code	60632548
Hospital Revenue Code	250
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$24.70

BETAGAN 0.25% OPHTH/5ML

Facility

$164.69

Service Code	NDC 23438505
Hospital Charge Code	60632548
Hospital Revenue Code	250
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$82.34
Rate for Payer: Aetna Commercial	$49.41
Rate for Payer: Aetna Medicare Advantage	$49.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.00
Rate for Payer: Cigna Commercial	$82.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.41
Rate for Payer: Oxford Commercial	$82.34
Rate for Payer: Qualcare PPO/HMO/WC	$24.70
Rate for Payer: UnitedHealthcare Commercial	$82.34

BETAGAN 0.5% OPHTH/2ML

Facility

$84.76

Service Code	NDC 23438505
Hospital Charge Code	60632549
Hospital Revenue Code	250
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$12.71
Rate for Payer: Qualcare PPO/HMO/WC	$12.71

BETAGAN 0.5% OPHTH/2ML

Facility

$84.76

Service Code	NDC 23438505
Hospital Charge Code	60632549
Hospital Revenue Code	250
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$42.38
Rate for Payer: Aetna Commercial	$25.43
Rate for Payer: Aetna Medicare Advantage	$25.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.61
Rate for Payer: Cigna Commercial	$42.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.02
Rate for Payer: Oxford Commercial	$42.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.71
Rate for Payer: UnitedHealthcare Commercial	$42.38

BETA HYDROXYBUTYRATE

Facility

$390.00

Service Code	HCPCS 82010
Hospital Charge Code	39900031
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BETA HYDROXYBUTYRATE

Facility

$390.00

Service Code	HCPCS 82010
Hospital Charge Code	39900031
Hospital Revenue Code	307
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.47
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.93
Rate for Payer: Cigna Commercial	$8.17
Rate for Payer: Cigna Medicare Advantage	$4.08
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
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	$8.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.66
Rate for Payer: Wellcare Medicare Advantage	$8.17

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038080
Hospital Revenue Code	307
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038080
Hospital Revenue Code	307
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.47
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.93
Rate for Payer: Cigna Commercial	$8.17
Rate for Payer: Cigna Medicare Advantage	$4.08
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.66
Rate for Payer: Wellcare Medicare Advantage	$8.17

BETA-HYDROXYBUTYRATE

Facility

$27.90

Service Code	HCPCS 82010
Hospital Charge Code	3038130
Hospital Revenue Code	300
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

Know your out-of-pocket cost for care.

All Charges