Heights University Hospital

All Charges

Charge

Type

Setting

Price

VOLATILES

Facility

$309.00

Service Code	HCPCS 84600
Hospital Charge Code	3035089D
Hospital Revenue Code	301
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

VOLATILES

Facility

$56.00

Service Code	HCPCS 82010
Hospital Charge Code	3035089B
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	$7.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
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

VOLATILES

Facility

$56.00

Service Code	HCPCS 82010
Hospital Charge Code	3035089B
Hospital Revenue Code	307
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

VOLATILES

Facility

$309.00

Service Code	HCPCS 84600
Hospital Charge Code	3035089D
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.44
Rate for Payer: Aetna Medicare Advantage	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.69
Rate for Payer: Cigna Commercial	$17.11
Rate for Payer: Cigna Medicare Advantage	$8.55
Rate for Payer: Clover Medicare Advantage	$16.25
Rate for Payer: EmblemHealth Commercial	$51.33
Rate for Payer: Humana Medicare Advantage	$17.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.14
Rate for Payer: Wellcare Medicare Advantage	$17.11

VOLTAGE-GATED CALCIUM CH

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900336
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VOLTAGE-GATED CALCIUM CH

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900336
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.62
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.42
Rate for Payer: Cigna Commercial	$18.40
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
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	$18.40
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.50
Rate for Payer: Wellcare Medicare Advantage	$18.40

VOLTAGE-GATED CALCIUM CHANNEL

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3038104
Hospital Revenue Code	301
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

VOLTAGE-GATED CALCIUM CHANNEL

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3038104
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

VOLTAREN/25MG/TAB

Facility

$6.00

Hospital Charge Code	60634165
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VOLTAREN/25MG/TAB

Facility

$6.00

Hospital Charge Code	60634165
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

VOLTAREN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60634166
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VOLTAREN/50MG/TAB

Facility

$6.00

Hospital Charge Code	60634166
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

VOLTAREN/50MG/TAB

Facility

$9.85

Service Code	NDC 51079046601
Hospital Charge Code	60634162
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: Aetna Medicare Advantage	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.51
Rate for Payer: Cigna Commercial	$4.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.28
Rate for Payer: Oxford Commercial	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.48
Rate for Payer: UnitedHealthcare Commercial	$4.92

VOLTAREN/50MG/TAB

Facility

$9.85

Service Code	NDC 51079046601
Hospital Charge Code	60634162
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.48

VOLTAREN/75MG/TAB

Facility

$5.00

Hospital Charge Code	60634167
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

VOLTAREN/75MG/TAB

Facility

$6.00

Hospital Charge Code	60634163
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VOLTAREN/75MG/TAB

Facility

$6.00

Hospital Charge Code	60634163
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

VOLTAREN/75MG/TAB

Facility

$5.00

Hospital Charge Code	60634167
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VOLTAREN OPHTHALMIC SOLN

Facility

$92.00

Hospital Charge Code	60634958
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

VOLTAREN OPHTHALMIC SOLN

Facility

$92.00

Hospital Charge Code	60634958
Hospital Revenue Code	250
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$46.00

VOLTREN XR 100MG UD TAB

Facility

$18.00

Hospital Charge Code	60635240
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

VOLTREN XR 100MG UD TAB

Facility

$18.00

Hospital Charge Code	60635240
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

VOLUMEN ORAL CONTRAST

Facility

$47.50

Service Code	NDC 32909092603
Hospital Charge Code	60635823
Hospital Revenue Code	250
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

VOLUMEN ORAL CONTRAST

Facility

$47.50

Service Code	NDC 32909092603
Hospital Charge Code	60635823
Hospital Revenue Code	250
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$23.75

VOLUME RESPIRATION***

Facility

$439.00

Service Code	HCPCS 94656
Hospital Charge Code	9500182
Hospital Revenue Code	419
Min. Negotiated Rate	$65.85
Max. Negotiated Rate	$65.85
Rate for Payer: Qualcare PPO/HMO/WC	$65.85

Know your out-of-pocket cost for care.

All Charges