Heights University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR TRIGGER FLEA 40 CM PRB

Facility

$3,750.00

Hospital Charge Code	270688728
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

BIRCH (T3) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900355
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BIRCH (T3) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900355
Hospital Revenue Code	305
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
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	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

BISACODYL/10MG/EACH

Facility

$1.00

Hospital Charge Code	60632567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

BISACODYL/10MG/EACH

Facility

$3.00

Hospital Charge Code	60632568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BISACODYL/10MG/EACH

Facility

$3.00

Hospital Charge Code	60632568
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

BISACODYL/10MG/EACH

Facility

$1.00

Hospital Charge Code	60632567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BISACODYL 10 MG SUPP

Facility

$4.00

Service Code	NDC 904505812
Hospital Charge Code	6023048
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

BISACODYL 10 MG SUPP

Facility

$4.00

Service Code	NDC 904505812
Hospital Charge Code	6023048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISACODYL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632570
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

BISACODYL/5MG/TAB

Facility

$1.00

Hospital Charge Code	60632569
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

BISACODYL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BISACODYL/5MG/TAB

Facility

$1.00

Hospital Charge Code	60632569
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BISACODYL 5MG TABLETS

Facility

$4.00

Service Code	NDC 52959067430
Hospital Charge Code	60628123
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISACODYL 5MG TABLETS

Facility

$4.00

Service Code	NDC 52959067430
Hospital Charge Code	60628123
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

BISACODYL TAB 5MG

Facility

$1.95

Hospital Charge Code	6022206
Hospital Revenue Code	257
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

BISACODYL TAB 5MG

Facility

$1.95

Hospital Charge Code	6022206
Hospital Revenue Code	257
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

BISMUTH MAGMA SSP 8 OZ

Facility

$21.15

Hospital Charge Code	6000707
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

BISMUTH MAGMA SSP 8 OZ

Facility

$21.15

Hospital Charge Code	6000707
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012280
Hospital Revenue Code	250
Min. Negotiated Rate	$66.44
Max. Negotiated Rate	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.44

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012272
Hospital Revenue Code	250
Min. Negotiated Rate	$66.44
Max. Negotiated Rate	$66.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.44

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012272
Hospital Revenue Code	250
Min. Negotiated Rate	$57.58
Max. Negotiated Rate	$221.45
Rate for Payer: Aetna Commercial	$132.87
Rate for Payer: Aetna Medicare Advantage	$132.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.94
Rate for Payer: Cigna Commercial	$221.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: Oxford Commercial	$221.45
Rate for Payer: Qualcare PPO/HMO/WC	$66.44
Rate for Payer: UnitedHealthcare Commercial	$221.45

BISMUTH SUBGALLATE POWDER

Facility

$442.90

Hospital Charge Code	6012280
Hospital Revenue Code	250
Min. Negotiated Rate	$57.58
Max. Negotiated Rate	$221.45
Rate for Payer: Aetna Commercial	$132.87
Rate for Payer: Aetna Medicare Advantage	$132.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.94
Rate for Payer: Cigna Commercial	$221.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: Oxford Commercial	$221.45
Rate for Payer: Qualcare PPO/HMO/WC	$66.44
Rate for Payer: UnitedHealthcare Commercial	$221.45

BISMUTH SUBGALLATE POWDER

Facility

$967.25

Hospital Charge Code	60628514
Hospital Revenue Code	250
Min. Negotiated Rate	$125.74
Max. Negotiated Rate	$483.62
Rate for Payer: Aetna Commercial	$290.18
Rate for Payer: Aetna Medicare Advantage	$290.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.65
Rate for Payer: Cigna Commercial	$483.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.74
Rate for Payer: Oxford Commercial	$483.62
Rate for Payer: Qualcare PPO/HMO/WC	$145.09
Rate for Payer: UnitedHealthcare Commercial	$483.62

BISMUTH SUBGALLATE POWDER

Facility

$967.25

Hospital Charge Code	60628514
Hospital Revenue Code	250
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$145.09
Rate for Payer: Qualcare PPO/HMO/WC	$145.09

Know your out-of-pocket cost for care.

All Charges