Heights University Hospital

All Charges

Charge

Type

Setting

Price

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$5.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.04

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.88
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: Cigna Medicare Advantage	$2.44
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.04
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.17
Rate for Payer: Wellcare Medicare Advantage	$4.88

BICILLIN C-R/1.2MU/2ML

Facility

$43.00

Hospital Charge Code	60632563
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

BICILLIN C-R/1.2MU/2ML

Facility

$43.00

Hospital Charge Code	60632563
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

BICILLIN C-R/600KU/1ML

Facility

$23.00

Hospital Charge Code	60632562
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

BICILLIN C-R/600KU/1ML

Facility

$23.00

Hospital Charge Code	60632562
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

BICILLIN LA/1.2MU/2ML

Facility

$66.00

Hospital Charge Code	60632566
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

BICILLIN LA/1.2MU/2ML

Facility

$66.00

Hospital Charge Code	60632566
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

BICILLIN L-A/2.4MU/4ML

Facility

$131.00

Hospital Charge Code	60632565
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

BICILLIN L-A/2.4MU/4ML

Facility

$131.00

Hospital Charge Code	60632565
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$31.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$25.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$51.76
Rate for Payer: Aetna Commercial	$31.06
Rate for Payer: Aetna Medicare Advantage	$31.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.40
Rate for Payer: Cigna Commercial	$51.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$6.74

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$4.36
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$7.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$7.27

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$111.13
Max. Negotiated Rate	$111.13
Rate for Payer: Qualcare PPO/HMO/WC	$111.13

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$96.32
Max. Negotiated Rate	$370.44
Rate for Payer: Aetna Commercial	$222.27
Rate for Payer: Aetna Medicare Advantage	$222.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.93
Rate for Payer: Cigna Commercial	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.32
Rate for Payer: Oxford Commercial	$370.44
Rate for Payer: Qualcare PPO/HMO/WC	$111.13
Rate for Payer: UnitedHealthcare Commercial	$370.44

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$188,006.94

Service Code	MSDRG 461
Min. Negotiated Rate	$54,508.27
Max. Negotiated Rate	$188,006.94
Rate for Payer: Aetna Commercial	$186,234.92
Rate for Payer: Aetna Medicare Advantage	$60,270.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188,006.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188,006.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$57,377.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188,006.94
Rate for Payer: Cigna Commercial	$115,365.47
Rate for Payer: Cigna Medicare Advantage	$57,377.13
Rate for Payer: Clover Medicare Advantage	$54,508.27
Rate for Payer: EmblemHealth Commercial	$172,131.39
Rate for Payer: Humana Medicare Advantage	$59,098.44
Rate for Payer: Oxford Commercial	$72,100.07
Rate for Payer: UnitedHealthcare Commercial	$81,840.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$57,377.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$60,819.76
Rate for Payer: Wellcare Medicare Advantage	$57,377.13

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$89,694.88

Service Code	MSDRG 462
Min. Negotiated Rate	$28,193.06
Max. Negotiated Rate	$89,694.88
Rate for Payer: Aetna Commercial	$89,694.88
Rate for Payer: Aetna Medicare Advantage	$29,027.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,565.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,565.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,676.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,565.95
Rate for Payer: Cigna Commercial	$57,245.86
Rate for Payer: Cigna Medicare Advantage	$29,676.90
Rate for Payer: Clover Medicare Advantage	$28,193.06
Rate for Payer: EmblemHealth Commercial	$89,030.70
Rate for Payer: Humana Medicare Advantage	$30,567.21
Rate for Payer: Oxford Commercial	$35,777.00
Rate for Payer: UnitedHealthcare Commercial	$40,610.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,676.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31,457.51
Rate for Payer: Wellcare Medicare Advantage	$29,676.90

BILAYER WOUND MATRIX 2X2

Facility

$9,890.00

Hospital Charge Code	270657166
Hospital Revenue Code	636
Min. Negotiated Rate	$1,483.50
Max. Negotiated Rate	$4,945.00
Rate for Payer: Aetna Commercial	$2,967.00
Rate for Payer: Aetna Medicare Advantage	$2,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,521.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,521.95
Rate for Payer: Cigna Commercial	$4,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

BILAYER WOUND MATRIX 2X2

Facility

$9,890.00

Hospital Charge Code	270657166
Hospital Revenue Code	636
Min. Negotiated Rate	$1,483.50
Max. Negotiated Rate	$2,393.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

BILAYER WOUND MATRIX 4X5

Facility

$16,665.00

Service Code	HCPCS Q4104
Hospital Charge Code	270648773
Hospital Revenue Code	278
Min. Negotiated Rate	$2,499.75
Max. Negotiated Rate	$4,032.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,032.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,499.75

BILAYER WOUND MATRIX 4X5

Facility

$16,665.00

Service Code	HCPCS Q4104
Hospital Charge Code	270648773
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,999.50
Rate for Payer: Aetna Commercial	$4,999.50
Rate for Payer: Aetna Medicare Advantage	$4,999.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,249.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,249.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,249.57
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,032.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,499.75

BILE ACIDS

Facility

$117.25

Service Code	HCPCS 82239
Hospital Charge Code	3038072
Hospital Revenue Code	300
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.47
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.73
Rate for Payer: Cigna Commercial	$17.12
Rate for Payer: Cigna Medicare Advantage	$8.56
Rate for Payer: Clover Medicare Advantage	$16.26
Rate for Payer: EmblemHealth Commercial	$51.36
Rate for Payer: Humana Medicare Advantage	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.15
Rate for Payer: Wellcare Medicare Advantage	$17.12

Know your out-of-pocket cost for care.

All Charges