Heights University Hospital

All Charges

Charge

Type

Setting

Price

BETHANECHOL CHLORIDE/5MG

Facility

$3.00

Hospital Charge Code	60632556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BETHANECHOL CHLORIDE/5MG

Facility

$3.00

Hospital Charge Code	60632556
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

BETHANECHOL INJ 5MG/ML

Facility

$43.55

Hospital Charge Code	6008932
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

BETHANECHOL INJ 5MG/ML

Facility

$43.55

Hospital Charge Code	6008932
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

BETOPTIC 0.5% OPHTH/10ML

Facility

$167.00

Hospital Charge Code	60632561
Hospital Revenue Code	250
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.71
Rate for Payer: Oxford Commercial	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$83.50

BETOPTIC 0.5% OPHTH/10ML

Facility

$167.00

Hospital Charge Code	60632561
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$55.23
Max. Negotiated Rate	$212.43
Rate for Payer: Aetna Commercial	$127.45
Rate for Payer: Aetna Medicare Advantage	$127.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.34
Rate for Payer: Cigna Commercial	$212.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.23
Rate for Payer: Oxford Commercial	$212.43
Rate for Payer: Qualcare PPO/HMO/WC	$63.73
Rate for Payer: UnitedHealthcare Commercial	$212.43

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$63.73
Max. Negotiated Rate	$63.73
Rate for Payer: Qualcare PPO/HMO/WC	$63.73

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$227.96
Max. Negotiated Rate	$876.76
Rate for Payer: Aetna Commercial	$526.06
Rate for Payer: Aetna Medicare Advantage	$526.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.15
Rate for Payer: Cigna Commercial	$876.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.96
Rate for Payer: Oxford Commercial	$876.76
Rate for Payer: Qualcare PPO/HMO/WC	$263.03
Rate for Payer: UnitedHealthcare Commercial	$876.76

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$263.03
Max. Negotiated Rate	$263.03
Rate for Payer: Qualcare PPO/HMO/WC	$263.03

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$87.10
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$201.00
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.10
Rate for Payer: Oxford Commercial	$335.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Commercial	$335.00

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: Qualcare PPO/HMO/WC	$433.50

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$1,445.00
Rate for Payer: Aetna Commercial	$867.00
Rate for Payer: Aetna Medicare Advantage	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$736.95
Rate for Payer: Cigna Commercial	$1,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: Qualcare PPO/HMO/WC	$433.50

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$162.53
Max. Negotiated Rate	$162.53
Rate for Payer: Qualcare PPO/HMO/WC	$162.53

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$162.53
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

B. HENSELAE

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072A
Hospital Revenue Code	300
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

B. HENSELAE

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072A
Hospital Revenue Code	300
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Aetna Commercial	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.30
Rate for Payer: Cigna Commercial	$10.18
Rate for Payer: Cigna Medicare Advantage	$5.09
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.79
Rate for Payer: Wellcare Medicare Advantage	$10.18

B. HENSELAE AB (IGG, IGM), I

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

B. HENSELAE AB (IGG, IGM), I

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

B. HENSELAE AB (IGG, IGM), II

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

B. HENSELAE AB (IGG, IGM), II

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

BHI AGAR W/VANCO

Facility

$50.00

Hospital Charge Code	270666700
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$25.00

Know your out-of-pocket cost for care.

All Charges