Heights University Hospital

All Charges

Charge

Type

Setting

Price

BISMUTH SUBSALICYLATE

Facility

$4.00

Service Code	NDC 37000003204
Hospital Charge Code	60628109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BISMUTH SUBSALICYLATE

Facility

$4.00

Service Code	NDC 37000003204
Hospital Charge Code	60628109
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

BISMUTH SUBSALICYLATE CHEW TAB

Facility

$2.45

Hospital Charge Code	60628108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

BISMUTH SUBSALICYLATE CHEW TAB

Facility

$2.45

Hospital Charge Code	60628108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

BISOPROLOL 5 MG TAB

Facility

$9.38

Service Code	NDC 29300012613
Hospital Charge Code	60630005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$2.81
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$4.69

BISOPROLOL 5 MG TAB

Facility

$9.38

Service Code	NDC 29300012613
Hospital Charge Code	60630005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

BIT AMD DRILL CANN AT-7032

Facility

$932.50

Hospital Charge Code	270621019
Hospital Revenue Code	272
Min. Negotiated Rate	$139.88
Max. Negotiated Rate	$139.88
Rate for Payer: Qualcare PPO/HMO/WC	$139.88

BIT AMD DRILL CANN AT-7032

Facility

$932.50

Hospital Charge Code	270621019
Hospital Revenue Code	272
Min. Negotiated Rate	$121.22
Max. Negotiated Rate	$466.25
Rate for Payer: Aetna Commercial	$279.75
Rate for Payer: Aetna Medicare Advantage	$279.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.79
Rate for Payer: Cigna Commercial	$466.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.22
Rate for Payer: Oxford Commercial	$466.25
Rate for Payer: Qualcare PPO/HMO/WC	$139.88
Rate for Payer: UnitedHealthcare Commercial	$466.25

BIT BMT DR 2.8 20 25-424505

Facility

$386.95

Hospital Charge Code	270628131
Hospital Revenue Code	272
Min. Negotiated Rate	$50.30
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$116.08
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.30
Rate for Payer: Oxford Commercial	$193.47
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Commercial	$193.47

BIT BMT DR 2.8 20 25-424505

Facility

$386.95

Hospital Charge Code	270628131
Hospital Revenue Code	272
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$58.04
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

BIT BMT DR 3.2 20 25-424508

Facility

$639.90

Hospital Charge Code	270615800
Hospital Revenue Code	272
Min. Negotiated Rate	$95.98
Max. Negotiated Rate	$95.98
Rate for Payer: Qualcare PPO/HMO/WC	$95.98

BIT BMT DR 3.2 20 25-424508

Facility

$639.90

Hospital Charge Code	270615800
Hospital Revenue Code	272
Min. Negotiated Rate	$83.19
Max. Negotiated Rate	$319.95
Rate for Payer: Aetna Commercial	$191.97
Rate for Payer: Aetna Medicare Advantage	$191.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.17
Rate for Payer: Cigna Commercial	$319.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.19
Rate for Payer: Oxford Commercial	$319.95
Rate for Payer: Qualcare PPO/HMO/WC	$95.98
Rate for Payer: UnitedHealthcare Commercial	$319.95

BIT BMT DR 3.2 40 25-424510

Facility

$500.00

Hospital Charge Code	270617803
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

BIT BMT DR 3.2 40 25-424510

Facility

$500.00

Hospital Charge Code	270617803
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BIT BMT DR 3.2 5.5 35463018

Facility

$610.00

Hospital Charge Code	270612878
Hospital Revenue Code	272
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

BIT BMT DR 3.2 5.5 35463018

Facility

$610.00

Hospital Charge Code	270612878
Hospital Revenue Code	272
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$305.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$305.00

BIT BMT DR 4.5 5.0 35463020

Facility

$420.85

Hospital Charge Code	270625700
Hospital Revenue Code	272
Min. Negotiated Rate	$63.13
Max. Negotiated Rate	$63.13
Rate for Payer: Qualcare PPO/HMO/WC	$63.13

BIT BMT DR 4.5 5.0 35463020

Facility

$420.85

Hospital Charge Code	270625700
Hospital Revenue Code	272
Min. Negotiated Rate	$54.71
Max. Negotiated Rate	$210.43
Rate for Payer: Aetna Commercial	$126.25
Rate for Payer: Aetna Medicare Advantage	$126.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.32
Rate for Payer: Cigna Commercial	$210.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.71
Rate for Payer: Oxford Commercial	$210.43
Rate for Payer: Qualcare PPO/HMO/WC	$63.13
Rate for Payer: UnitedHealthcare Commercial	$210.43

BIT BMT DR SNAP 4.3 471878

Facility

$752.00

Hospital Charge Code	270614895
Hospital Revenue Code	272
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$112.80

BIT BMT DR SNAP 4.3 471878

Facility

$752.00

Hospital Charge Code	270614895
Hospital Revenue Code	272
Min. Negotiated Rate	$97.76
Max. Negotiated Rate	$376.00
Rate for Payer: Aetna Commercial	$225.60
Rate for Payer: Aetna Medicare Advantage	$225.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.76
Rate for Payer: Cigna Commercial	$376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.76
Rate for Payer: Oxford Commercial	$376.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.80
Rate for Payer: UnitedHealthcare Commercial	$376.00

BIT BX DRL 2.0 DR20272

Facility

$192.85

Hospital Charge Code	270620187
Hospital Revenue Code	272
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$96.42
Rate for Payer: Aetna Commercial	$57.85
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$96.42
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$96.42

BIT BX DRL 2.0 DR20272

Facility

$192.85

Hospital Charge Code	270620187
Hospital Revenue Code	272
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

BIT CRANIAL PERFORATOR DISP LG

Facility

$948.75

Hospital Charge Code	270676207
Hospital Revenue Code	272
Min. Negotiated Rate	$142.31
Max. Negotiated Rate	$142.31
Rate for Payer: Qualcare PPO/HMO/WC	$142.31

BIT CRANIAL PERFORATOR DISP LG

Facility

$948.75

Hospital Charge Code	270676207
Hospital Revenue Code	272
Min. Negotiated Rate	$123.34
Max. Negotiated Rate	$474.38
Rate for Payer: Aetna Commercial	$284.62
Rate for Payer: Aetna Medicare Advantage	$284.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.93
Rate for Payer: Cigna Commercial	$474.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.34
Rate for Payer: Oxford Commercial	$474.38
Rate for Payer: Qualcare PPO/HMO/WC	$142.31
Rate for Payer: UnitedHealthcare Commercial	$474.38

BIT DPY DR 5MM PIN FF10503

Facility

$1,127.25

Hospital Charge Code	270612440
Hospital Revenue Code	272
Min. Negotiated Rate	$146.54
Max. Negotiated Rate	$563.62
Rate for Payer: Aetna Commercial	$338.18
Rate for Payer: Aetna Medicare Advantage	$338.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.45
Rate for Payer: Cigna Commercial	$563.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.54
Rate for Payer: Oxford Commercial	$563.62
Rate for Payer: Qualcare PPO/HMO/WC	$169.09
Rate for Payer: UnitedHealthcare Commercial	$563.62

Know your out-of-pocket cost for care.

All Charges