Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509056
Hospital Revenue Code	912
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509056
Hospital Revenue Code	912
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17.91

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Hospital Charge Code	84050954
Hospital Revenue Code	912
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR 21 YR+

Facility

$800.80

Hospital Charge Code	84050954
Hospital Revenue Code	912
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CAID PHP TREATMENT/HR <21 YRS

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509057
Hospital Revenue Code	913
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17.91

CAID PHP TREATMENT/HR <21 YRS

Facility

$800.80

Service Code	HCPCS H0035
Hospital Charge Code	84509057
Hospital Revenue Code	913
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

CALADRYL/180ML

Facility

$8.00

Hospital Charge Code	60632597
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

CALADRYL/180ML

Facility

$8.00

Hospital Charge Code	60632597
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CALAMINE/120ML

Facility

$6.00

Hospital Charge Code	60632599
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CALAMINE/120ML

Facility

$18.96

Service Code	NDC 395041396
Hospital Charge Code	60632598
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$5.69
Rate for Payer: Aetna Medicare Advantage	$5.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.83
Rate for Payer: Cigna Commercial	$9.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.46
Rate for Payer: Oxford Commercial	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.84
Rate for Payer: UnitedHealthcare Commercial	$9.48

CALAMINE/120ML

Facility

$3.00

Hospital Charge Code	60632600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CALAMINE/120ML

Facility

$6.00

Hospital Charge Code	60632599
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

CALAMINE/120ML

Facility

$18.96

Service Code	NDC 395041396
Hospital Charge Code	60632598
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.84

CALAMINE/120ML

Facility

$3.00

Hospital Charge Code	60632600
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

CALAMINE PRAMOXINE LOTN

Facility

$47.25

Hospital Charge Code	60628410
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

CALAMINE PRAMOXINE LOTN

Facility

$47.25

Hospital Charge Code	60628410
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.14
Rate for Payer: Oxford Commercial	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$23.62

C.ALBICANS ABS (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

C.ALBICANS ABS (IGG,A,M) I

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C.ALBICANS ABS (IGG,A,M) II

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

C.ALBICANS ABS (IGG,A,M) II

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C.ALBICANS ABS (IGG,A,M) III

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C.ALBICANS ABS (IGG,A,M) III

Facility

$390.00

Service Code	HCPCS 8662891
Hospital Charge Code	39990088C
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

CALCANCEAL OSTEOTOMY DRY

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690329
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

CALCANCEAL OSTEOTOMY DRY

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690329
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

CALCANEUS REMOVAL

Facility

$19,998.60

Service Code	HCPCS 28118
Hospital Charge Code	16000514
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

Know your out-of-pocket cost for care.

All Charges