Heights University Hospital

All Charges

Charge

Type

Setting

Price

BORDETELLA PERTUSSIS ANTIBODY

Facility

$309.65

Service Code	HCPCS 87265
Hospital Charge Code	3009784
Hospital Revenue Code	309
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
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	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.48
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.29
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: Cigna Medicare Advantage	$3.31
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
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	$6.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.03
Rate for Payer: Wellcare Medicare Advantage	$6.63

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BORIC ACID OINT 5%

Facility

$53.80

Hospital Charge Code	6000723
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

BORIC ACID OINT 5%

Facility

$53.80

Hospital Charge Code	6000723
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$1,933.22
Max. Negotiated Rate	$3,118.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3,866.44
Rate for Payer: Aetna Commercial	$3,866.44
Rate for Payer: Aetna Medicare Advantage	$3,866.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,286.47
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22

BOSENTAN (TRACLEER) 125MG TAB

Facility

$666.00

Hospital Charge Code	60630185
Hospital Revenue Code	250
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$99.90
Rate for Payer: Qualcare PPO/HMO/WC	$99.90

BOSENTAN (TRACLEER) 125MG TAB

Facility

$666.00

Hospital Charge Code	60630185
Hospital Revenue Code	250
Min. Negotiated Rate	$86.58
Max. Negotiated Rate	$333.00
Rate for Payer: Aetna Commercial	$199.80
Rate for Payer: Aetna Medicare Advantage	$199.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.83
Rate for Payer: Cigna Commercial	$333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.58
Rate for Payer: Oxford Commercial	$333.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.90
Rate for Payer: UnitedHealthcare Commercial	$333.00

BOTLE DEVIBISS CLEAR 1OZ

Facility

$42.80

Hospital Charge Code	270655906
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$21.40
Rate for Payer: Aetna Commercial	$12.84
Rate for Payer: Aetna Medicare Advantage	$12.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.91
Rate for Payer: Cigna Commercial	$21.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.56
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.42
Rate for Payer: UnitedHealthcare Commercial	$21.40

BOTLE DEVIBISS CLEAR 1OZ

Facility

$42.80

Hospital Charge Code	270655906
Hospital Revenue Code	270
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.42

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$1,345.90
Max. Negotiated Rate	$2,171.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$1,345.90
Max. Negotiated Rate	$2,691.79
Rate for Payer: Aetna Commercial	$2,691.79
Rate for Payer: Aetna Medicare Advantage	$2,691.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90

BOTTLE CLEANSING 8OZ

Facility

$5.65

Hospital Charge Code	270600534
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

BOTTLE CLEANSING 8OZ

Facility

$5.65

Hospital Charge Code	270600534
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

BOTTLE EVENFLO 8 OZ

Facility

$233.00

Hospital Charge Code	270654313
Hospital Revenue Code	270
Min. Negotiated Rate	$30.29
Max. Negotiated Rate	$116.50
Rate for Payer: Aetna Commercial	$69.90
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.29
Rate for Payer: Oxford Commercial	$116.50
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$116.50

BOTTLE EVENFLO 8 OZ

Facility

$233.00

Hospital Charge Code	270654313
Hospital Revenue Code	270
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

BOTTLE HOT WATER PERS DISP

Facility

$29.65

Hospital Charge Code	270300426
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

BOTTLE HOT WATER PERS DISP

Facility

$29.65

Hospital Charge Code	270300426
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BOTTLE HUMIDIFIER DISP

Facility

$6.47

Hospital Charge Code	270651655
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$3.23
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare Advantage	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.65
Rate for Payer: Cigna Commercial	$3.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.84
Rate for Payer: Oxford Commercial	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.97
Rate for Payer: UnitedHealthcare Commercial	$3.23

BOTTLE HUMIDIFIER DISP

Facility

$6.47

Hospital Charge Code	270651655
Hospital Revenue Code	270
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.97

BOTTLE SPRAY FILM BARRIER 28ml

Facility

$37.13

Hospital Charge Code	270641452
Hospital Revenue Code	270
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.57

BOTTLE SPRAY FILM BARRIER 28ml

Facility

$37.13

Hospital Charge Code	270641452
Hospital Revenue Code	270
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$18.57
Rate for Payer: Aetna Commercial	$11.14
Rate for Payer: Aetna Medicare Advantage	$11.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.47
Rate for Payer: Cigna Commercial	$18.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.83
Rate for Payer: Oxford Commercial	$18.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.57
Rate for Payer: UnitedHealthcare Commercial	$18.57

Know your out-of-pocket cost for care.

All Charges