Heights University Hospital

All Charges

Charge

Type

Setting

Price

COMP SCREEN MAMMO ADD ON-PC

Facility

$16.50

Service Code	HCPCS 7705226
Hospital Charge Code	85000090
Hospital Revenue Code	403
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

COMP SCREEN MAMMO ADD ON-PC

Facility

$16.50

Service Code	HCPCS 7705226
Hospital Charge Code	85000090
Hospital Revenue Code	403
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$4.95
Rate for Payer: Aetna Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.21
Rate for Payer: Cigna Commercial	$8.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.48
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

COMP SCREEN MAMMO ADD ON-TC

Facility

$46.20

Service Code	HCPCS 77052TC
Hospital Charge Code	85000085
Hospital Revenue Code	403
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$6.93
Rate for Payer: Qualcare PPO/HMO/WC	$6.93

COMP SCREEN MAMMO ADD ON-TC

Facility

$46.20

Service Code	HCPCS 77052TC
Hospital Charge Code	85000085
Hospital Revenue Code	403
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$13.86
Rate for Payer: Aetna Medicare Advantage	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.78
Rate for Payer: Cigna Commercial	$23.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.93
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

COMP SERVICE PAT CELL SUPPLIES

Facility

$3,000.00

Hospital Charge Code	270680696
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

COMP SERVICE PAT CELL SUPPLIES

Facility

$3,000.00

Hospital Charge Code	270680696
Hospital Revenue Code	272
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$1,500.00

COMPT BMT FEM 12 X 140 162672

Facility

$19,349.00

Hospital Charge Code	270617804
Hospital Revenue Code	278
Min. Negotiated Rate	$2,902.35
Max. Negotiated Rate	$9,674.50
Rate for Payer: Aetna Commercial	$5,804.70
Rate for Payer: Aetna Medicare Advantage	$5,804.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,933.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,933.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,869.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,933.99
Rate for Payer: Cigna Commercial	$9,674.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,682.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,902.35

COMPT BMT FEM 12 X 140 162672

Facility

$19,349.00

Hospital Charge Code	270617804
Hospital Revenue Code	278
Min. Negotiated Rate	$2,902.35
Max. Negotiated Rate	$4,682.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,869.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,682.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,902.35

COMPT BMT FEM 12 X 140 162673

Facility

$17,860.00

Hospital Charge Code	270617009
Hospital Revenue Code	278
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$4,322.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,322.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,679.00

COMPT BMT FEM 12 X 140 162673

Facility

$17,860.00

Hospital Charge Code	270617009
Hospital Revenue Code	278
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$8,930.00
Rate for Payer: Aetna Commercial	$5,358.00
Rate for Payer: Aetna Medicare Advantage	$5,358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,554.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,554.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,554.30
Rate for Payer: Cigna Commercial	$8,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,322.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,679.00

COMPT BMT FEM 17 X 165 162617

Facility

$15,475.25

Hospital Charge Code	270627441
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.29
Max. Negotiated Rate	$7,737.62
Rate for Payer: Aetna Commercial	$4,642.57
Rate for Payer: Aetna Medicare Advantage	$4,642.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,946.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,946.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,946.19
Rate for Payer: Cigna Commercial	$7,737.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,745.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.29

COMPT BMT FEM 17 X 165 162617

Facility

$15,475.25

Hospital Charge Code	270627441
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.29
Max. Negotiated Rate	$3,745.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,745.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.29

COMPT BMT FEM LT 70 145133

Facility

$9,910.00

Hospital Charge Code	270617363
Hospital Revenue Code	278
Min. Negotiated Rate	$1,486.50
Max. Negotiated Rate	$2,398.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,982.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,398.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,486.50

COMPT BMT FEM LT 70 145133

Facility

$9,910.00

Hospital Charge Code	270617363
Hospital Revenue Code	278
Min. Negotiated Rate	$1,486.50
Max. Negotiated Rate	$4,955.00
Rate for Payer: Aetna Commercial	$2,973.00
Rate for Payer: Aetna Medicare Advantage	$2,973.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,527.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,527.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,982.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,527.05
Rate for Payer: Cigna Commercial	$4,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,398.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,486.50

COMP TINC OF BENZOIN

Facility

$11.00

Hospital Charge Code	60635880
Hospital Revenue Code	259
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$5.50

COMP TINC OF BENZOIN

Facility

$11.00

Hospital Charge Code	60635880
Hospital Revenue Code	259
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

COMP TT SHLDR GD AND BN L

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692347
Hospital Revenue Code	278
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

COMP TT SHLDR GD AND BN L

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692347
Hospital Revenue Code	278
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$1,379.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

CON ASY REPL 15FR 13cmCAR03200

Facility

$250.00

Hospital Charge Code	270632036
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

CON ASY REPL 15FR 13cmCAR03200

Facility

$250.00

Hospital Charge Code	270632036
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CONCELLTRATE 100DBM 10CC JAR

Facility

$7,000.00

Hospital Charge Code	270673664
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONCELLTRATE 100DBM 10CC JAR

Facility

$7,000.00

Hospital Charge Code	270673664
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONCERTA 18MG TAB

Facility

$65.19

Service Code	NDC 591271501
Hospital Charge Code	6063943086
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$32.59
Rate for Payer: Aetna Commercial	$19.56
Rate for Payer: Aetna Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.62
Rate for Payer: Cigna Commercial	$32.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Oxford Commercial	$32.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.78
Rate for Payer: UnitedHealthcare Commercial	$32.59

CONCERTA 18MG TAB

Facility

$65.19

Service Code	NDC 591271501
Hospital Charge Code	6063943086
Hospital Revenue Code	250
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$9.78
Rate for Payer: Qualcare PPO/HMO/WC	$9.78

CONCERTA 27MG TAB

Facility

$50.12

Service Code	NDC 55289097590
Hospital Charge Code	6063943087
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$7.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.52

Know your out-of-pocket cost for care.

All Charges