Heights University Hospital

All Charges

Charge

Type

Setting

Price

ADD-A-VIAL BINARY CONNECT INJ

Facility

$5.00

Hospital Charge Code	60629211
Hospital Revenue Code	270
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

ADD-A-VIAL BINARY CONNECT INJ

Facility

$5.00

Hospital Charge Code	60629211
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ADDITIONAL BLOOD UNITS X MATCH

Facility

$170.45

Service Code	HCPCS 86922
Hospital Charge Code	3100914
Hospital Revenue Code	300
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$51.13
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ADDITIONAL BLOOD UNITS X MATCH

Facility

$170.45

Service Code	HCPCS 86922
Hospital Charge Code	3100914
Hospital Revenue Code	300
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

ADDITIONAL SPINAL- FUSION

Facility

$22,894.84

Service Code	HCPCS 22585
Hospital Charge Code	16000498
Hospital Revenue Code	360
Min. Negotiated Rate	$3,434.23
Max. Negotiated Rate	$3,434.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,434.23

ADDITIONAL SPINAL- FUSION

Facility

$22,894.84

Service Code	HCPCS 22585
Hospital Charge Code	16000498
Hospital Revenue Code	360
Min. Negotiated Rate	$311.22
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$6,868.45
Rate for Payer: Aetna Medicare Advantage	$6,868.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,838.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,838.18
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	$5,838.18
Rate for Payer: Cigna Commercial	$311.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.33
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,434.23
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

ADD SET IN OR

Facility

$840.00

Hospital Charge Code	2009035
Hospital Revenue Code	320
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

ADD SET IN OR

Facility

$840.00

Hospital Charge Code	2009035
Hospital Revenue Code	320
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$252.00
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	411037185
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	411037185
Hospital Revenue Code	361
Min. Negotiated Rate	$151.71
Max. Negotiated Rate	$3,523.20
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
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	$2,994.72
Rate for Payer: Cigna Commercial	$151.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	7411125
Hospital Revenue Code	361
Min. Negotiated Rate	$151.71
Max. Negotiated Rate	$3,523.20
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
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	$2,994.72
Rate for Payer: Cigna Commercial	$151.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	366837185
Hospital Revenue Code	361
Min. Negotiated Rate	$151.71
Max. Negotiated Rate	$3,523.20
Rate for Payer: Aetna Commercial	$3,523.20
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
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	$2,994.72
Rate for Payer: Cigna Commercial	$151.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,526.72
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	7411125
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	366837185
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADD WALKER CAST

Facility

$468.75

Service Code	HCPCS 29440
Hospital Charge Code	5780150
Hospital Revenue Code	450
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$386.97
Rate for Payer: Aetna Commercial	$140.62
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.53
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.94
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

ADD WALKER CAST

Facility

$468.75

Service Code	HCPCS 29440
Hospital Charge Code	5780150
Hospital Revenue Code	450
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

ADEFOVIR DIPIVOXIL 10 MG Tab

Facility

$162.60

Hospital Charge Code	60630051
Hospital Revenue Code	250
Min. Negotiated Rate	$21.14
Max. Negotiated Rate	$81.30
Rate for Payer: Aetna Commercial	$48.78
Rate for Payer: Aetna Medicare Advantage	$48.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.46
Rate for Payer: Cigna Commercial	$81.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.14
Rate for Payer: Oxford Commercial	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.39
Rate for Payer: UnitedHealthcare Commercial	$81.30

ADEFOVIR DIPIVOXIL 10 MG Tab

Facility

$162.60

Hospital Charge Code	60630051
Hospital Revenue Code	250
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$24.39
Rate for Payer: Qualcare PPO/HMO/WC	$24.39

ADENOCARD 12MG/4ML SYRING

Facility

$82.00

Hospital Charge Code	60635491
Hospital Revenue Code	636
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$19.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

ADENOCARD 12MG/4ML SYRING

Facility

$82.00

Hospital Charge Code	60635491
Hospital Revenue Code	636
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

ADENOCARD 12MG/4ML VIAL

Facility

$183.45

Service Code	HCPCS J0153
Hospital Charge Code	60635637
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$55.03
Rate for Payer: Aetna Commercial	$55.03
Rate for Payer: Aetna Medicare Advantage	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.78
Rate for Payer: Cigna Commercial	$0.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.52

ADENOCARD 12MG/4ML VIAL

Facility

$183.45

Service Code	HCPCS J0153
Hospital Charge Code	60635637
Hospital Revenue Code	636
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$44.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.52

ADENOIDECTOMY,AGE 12 OR OVER

Facility

$22,083.40

Service Code	HCPCS 42831
Hospital Charge Code	1600000635
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$6,625.02
Rate for Payer: Aetna Medicare Advantage	$6,625.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,631.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,631.27
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	$5,631.27
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.84
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

ADENOIDECTOMY,AGE 12 OR OVER

Facility

$22,083.40

Service Code	HCPCS 42831
Hospital Charge Code	1600000635
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

ADENOSINE 6 MG/2 ML INJ

Facility

$42.61

Service Code	HCPCS J0153
Hospital Charge Code	60627544
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$12.78
Rate for Payer: Aetna Commercial	$12.78
Rate for Payer: Aetna Medicare Advantage	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.87
Rate for Payer: Cigna Commercial	$0.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.39

Know your out-of-pocket cost for care.

All Charges