Heights University Hospital

All Charges

Charge

Type

Setting

Price

BLD TYPE & RH***

Facility

$22.00

Service Code	HCPCS 86900
Hospital Charge Code	3000486
Hospital Revenue Code	309
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$9.69
Rate for Payer: Aetna Medicare Advantage	$2.99
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) Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$1.50
Rate for Payer: Clover Medicare Advantage	$2.84
Rate for Payer: EmblemHealth Commercial	$8.97
Rate for Payer: Humana Medicare Advantage	$3.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.17
Rate for Payer: Wellcare Medicare Advantage	$2.99

BLD TYPE & RH***

Facility

$18.00

Hospital Charge Code	3010485
Hospital Revenue Code	309
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$114.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

BLD TYPE & RH***

Facility

$18.00

Hospital Charge Code	3010485
Hospital Revenue Code	309
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

BLD TYPE: RH PHENOTYPING

Facility

$159.00

Service Code	HCPCS 86906
Hospital Charge Code	38471074
Hospital Revenue Code	309
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

BLD TYPE: RH PHENOTYPING

Facility

$159.00

Service Code	HCPCS 86906
Hospital Charge Code	38471074
Hospital Revenue Code	309
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.11
Rate for Payer: Aetna Medicare Advantage	$7.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.40
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.36
Rate for Payer: EmblemHealth Commercial	$23.25
Rate for Payer: Humana Medicare Advantage	$7.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.21
Rate for Payer: Wellcare Medicare Advantage	$7.75

BLEEDING TIME

Facility

$194.00

Service Code	HCPCS 85002
Hospital Charge Code	38478023
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.62
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.66
Rate for Payer: Cigna Commercial	$4.82
Rate for Payer: Cigna Medicare Advantage	$2.41
Rate for Payer: Clover Medicare Advantage	$4.58
Rate for Payer: EmblemHealth Commercial	$14.46
Rate for Payer: Humana Medicare Advantage	$4.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.11
Rate for Payer: Wellcare Medicare Advantage	$4.82

BLEEDING TIME

Facility

$194.00

Service Code	HCPCS 85002
Hospital Charge Code	38478023
Hospital Revenue Code	301
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

BLEEDING TIME (IVY)

Facility

$71.25

Service Code	HCPCS 85002
Hospital Charge Code	3002466
Hospital Revenue Code	301
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

BLEEDING TIME (IVY)

Facility

$71.25

Service Code	HCPCS 85002
Hospital Charge Code	3002466
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.62
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.66
Rate for Payer: Cigna Commercial	$4.82
Rate for Payer: Cigna Medicare Advantage	$2.41
Rate for Payer: Clover Medicare Advantage	$4.58
Rate for Payer: EmblemHealth Commercial	$14.46
Rate for Payer: Humana Medicare Advantage	$4.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.11
Rate for Payer: Wellcare Medicare Advantage	$4.82

BLENOXANE/15U

Facility

$991.00

Hospital Charge Code	60632571
Hospital Revenue Code	250
Min. Negotiated Rate	$148.65
Max. Negotiated Rate	$148.65
Rate for Payer: Qualcare PPO/HMO/WC	$148.65

BLENOXANE/15U

Facility

$991.00

Hospital Charge Code	60632571
Hospital Revenue Code	250
Min. Negotiated Rate	$128.83
Max. Negotiated Rate	$495.50
Rate for Payer: Aetna Commercial	$297.30
Rate for Payer: Aetna Medicare Advantage	$297.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.71
Rate for Payer: Cigna Commercial	$495.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.83
Rate for Payer: Oxford Commercial	$495.50
Rate for Payer: Qualcare PPO/HMO/WC	$148.65
Rate for Payer: UnitedHealthcare Commercial	$495.50

BLEOMYCIN 15 UNITS INJ

Facility

$459.89

Service Code	HCPCS J9040
Hospital Charge Code	6000715
Hospital Revenue Code	636
Min. Negotiated Rate	$16.60
Max. Negotiated Rate	$137.97
Rate for Payer: Aetna Commercial	$137.97
Rate for Payer: Aetna Medicare Advantage	$137.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.27
Rate for Payer: Cigna Commercial	$16.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.29
Rate for Payer: Qualcare PPO/HMO/WC	$68.98

BLEOMYCIN 15 UNITS INJ

Facility

$459.89

Service Code	HCPCS J9040
Hospital Charge Code	6000715
Hospital Revenue Code	636
Min. Negotiated Rate	$68.98
Max. Negotiated Rate	$111.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.29
Rate for Payer: Qualcare PPO/HMO/WC	$68.98

BLEPH-10 10% OPHTH/15ML

Facility

$65.00

Hospital Charge Code	60632572
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

BLEPH-10 10% OPHTH/15ML

Facility

$65.00

Hospital Charge Code	60632572
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$32.50

BLEPH-10 10% OPHTH/5ML

Facility

$772.78

Service Code	NDC 11980001105
Hospital Charge Code	60632573
Hospital Revenue Code	250
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$115.92
Rate for Payer: Qualcare PPO/HMO/WC	$115.92

BLEPH-10 10% OPHTH/5ML

Facility

$772.78

Service Code	NDC 11980001105
Hospital Charge Code	60632573
Hospital Revenue Code	250
Min. Negotiated Rate	$100.46
Max. Negotiated Rate	$386.39
Rate for Payer: Aetna Commercial	$231.83
Rate for Payer: Aetna Medicare Advantage	$231.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.06
Rate for Payer: Cigna Commercial	$386.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.46
Rate for Payer: Oxford Commercial	$386.39
Rate for Payer: Qualcare PPO/HMO/WC	$115.92
Rate for Payer: UnitedHealthcare Commercial	$386.39

BLEPH-10 OPHTH SOLU

Facility

$66.00

Hospital Charge Code	60635318
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
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	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

BLEPH-10 OPHTH SOLU

Facility

$66.00

Hospital Charge Code	60635318
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

BLEPH-10 OTHTH OINT

Facility

$51.00

Hospital Charge Code	60635319
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

BLEPH-10 OTHTH OINT

Facility

$51.00

Hospital Charge Code	60635319
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

BLEPHAMIDE LIQUIFILM 0.2%

Facility

$157.45

Service Code	NDC 11980002210
Hospital Charge Code	60632574
Hospital Revenue Code	250
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

BLEPHAMIDE LIQUIFILM 0.2%

Facility

$157.45

Service Code	NDC 11980002210
Hospital Charge Code	60632574
Hospital Revenue Code	250
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$78.72
Rate for Payer: Aetna Commercial	$47.23
Rate for Payer: Aetna Medicare Advantage	$47.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.15
Rate for Payer: Cigna Commercial	$78.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.47
Rate for Payer: Oxford Commercial	$78.72
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$78.72

BLEPHAROPLASTY L EYELID,

Facility

$16,286.20

Service Code	HCPCS 15820
Hospital Charge Code	16000786
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

BLEPHAROPLASTY L EYELID,

Facility

$16,286.20

Service Code	HCPCS 15820
Hospital Charge Code	16000786
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$4,885.86
Rate for Payer: Aetna Medicare Advantage	$4,885.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,152.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,152.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,152.98
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.21
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

Know your out-of-pocket cost for care.

All Charges