Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$11.85
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.07
Rate for Payer: Cigna Commercial	$19.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.13
Rate for Payer: Oxford Commercial	$19.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.92
Rate for Payer: UnitedHealthcare Commercial	$19.75

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$318.00

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$318.00

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$10,890.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$8,971.75
Rate for Payer: Aetna Commercial	$5,383.05
Rate for Payer: Aetna Medicare Advantage	$5,383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,575.59
Rate for Payer: Cigna Commercial	$8,971.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$4,342.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

CONSTRUCT BOWEL BLADDER

Facility

$27,828.20

Service Code	HCPCS 27828.2
Hospital Charge Code	1600000524
Hospital Revenue Code	360
Min. Negotiated Rate	$4,174.23
Max. Negotiated Rate	$4,174.23
Rate for Payer: Qualcare PPO/HMO/WC	$4,174.23

CONSTRUCT BOWEL BLADDER

Facility

$27,828.20

Service Code	HCPCS 27828.2
Hospital Charge Code	1600000524
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,914.10
Rate for Payer: Aetna Commercial	$8,348.46
Rate for Payer: Aetna Medicare Advantage	$8,348.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,096.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,096.19
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	$7,096.19
Rate for Payer: Cigna Commercial	$13,914.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,617.67
Rate for Payer: Qualcare PPO/HMO/WC	$4,174.23

CONSULTATION COMPREHENSIVE

Facility

$342.65

Service Code	HCPCS 88325
Hospital Charge Code	38477205
Hospital Revenue Code	312
Min. Negotiated Rate	$51.40
Max. Negotiated Rate	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$51.40

CONSULTATION COMPREHENSIVE

Facility

$342.65

Service Code	HCPCS 88325
Hospital Charge Code	38477205
Hospital Revenue Code	312
Min. Negotiated Rate	$44.54
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$102.80
Rate for Payer: Aetna Medicare Advantage	$102.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.38
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$60.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

CONSULTATION EXAPANDED 30 MIN

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	75190240
Hospital Revenue Code	510
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

CONSULTATION EXAPANDED 30 MIN

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	75190240
Hospital Revenue Code	510
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

CONSULTATION HIGH COMPLEXITY

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	75190245
Hospital Revenue Code	510
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

CONSULTATION HIGH COMPLEXITY

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	75190245
Hospital Revenue Code	510
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.71
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

CONTAINER CHEMOTHERAPY 2GAL

Facility

$18.47

Hospital Charge Code	270649381
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

CONTAINER CHEMOTHERAPY 2GAL

Facility

$18.47

Hospital Charge Code	270649381
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.23
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$9.23

CONTAINER IMPLANT 2.7 NEURO

Facility

$2,108.00

Hospital Charge Code	270610954
Hospital Revenue Code	272
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$316.20
Rate for Payer: Qualcare PPO/HMO/WC	$316.20

CONTAINER IMPLANT 2.7 NEURO

Facility

$2,108.00

Hospital Charge Code	270610954
Hospital Revenue Code	272
Min. Negotiated Rate	$274.04
Max. Negotiated Rate	$1,054.00
Rate for Payer: Aetna Commercial	$632.40
Rate for Payer: Aetna Medicare Advantage	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$537.54
Rate for Payer: Cigna Commercial	$1,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.04
Rate for Payer: Oxford Commercial	$1,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$316.20
Rate for Payer: UnitedHealthcare Commercial	$1,054.00

CONTAINER PLASTIC MONOJECT 4QT

Facility

$21.00

Hospital Charge Code	270665393
Hospital Revenue Code	270
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

CONTAINER PLASTIC MONOJECT 4QT

Facility

$21.00

Hospital Charge Code	270665393
Hospital Revenue Code	270
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

CONTAINER SPEC 4oz STER

Facility

$497.75

Hospital Charge Code	270651891
Hospital Revenue Code	272
Min. Negotiated Rate	$64.71
Max. Negotiated Rate	$248.88
Rate for Payer: Aetna Commercial	$149.32
Rate for Payer: Aetna Medicare Advantage	$149.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.93
Rate for Payer: Cigna Commercial	$248.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.71
Rate for Payer: Oxford Commercial	$248.88
Rate for Payer: Qualcare PPO/HMO/WC	$74.66
Rate for Payer: UnitedHealthcare Commercial	$248.88

CONTAINER SPEC 4oz STER

Facility

$497.75

Hospital Charge Code	270651891
Hospital Revenue Code	272
Min. Negotiated Rate	$74.66
Max. Negotiated Rate	$74.66
Rate for Payer: Qualcare PPO/HMO/WC	$74.66

Know your out-of-pocket cost for care.

All Charges