Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONTRAST VISIPAQUE 320MG/1ML

Facility

$5.96

Hospital Charge Code	270642100C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

CONTRAST VISIPAQUE 320mg 200ml

Facility

$393.73

Hospital Charge Code	270642173
Hospital Revenue Code	272
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$196.87
Rate for Payer: Aetna Commercial	$118.12
Rate for Payer: Aetna Medicare Advantage	$118.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.40
Rate for Payer: Cigna Commercial	$196.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.18
Rate for Payer: Oxford Commercial	$196.87
Rate for Payer: Qualcare PPO/HMO/WC	$59.06
Rate for Payer: UnitedHealthcare Commercial	$196.87

CONTRAST VISIPAQUE 320mg 200ml

Facility

$393.73

Hospital Charge Code	270642173
Hospital Revenue Code	272
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$59.06
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$18.68
Rate for Payer: Qualcare PPO/HMO/WC	$18.68

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$62.28
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.76
Rate for Payer: Cigna Commercial	$62.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.19
Rate for Payer: Oxford Commercial	$62.28
Rate for Payer: Qualcare PPO/HMO/WC	$18.68
Rate for Payer: UnitedHealthcare Commercial	$62.28

CONTROL FLOW CSF W/ BIO GLIDE

Facility

$4,137.65

Hospital Charge Code	270612860
Hospital Revenue Code	272
Min. Negotiated Rate	$620.65
Max. Negotiated Rate	$620.65
Rate for Payer: Qualcare PPO/HMO/WC	$620.65

CONTROL FLOW CSF W/ BIO GLIDE

Facility

$4,137.65

Hospital Charge Code	270612860
Hospital Revenue Code	272
Min. Negotiated Rate	$537.89
Max. Negotiated Rate	$2,068.82
Rate for Payer: Aetna Commercial	$1,241.30
Rate for Payer: Aetna Medicare Advantage	$1,241.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,055.10
Rate for Payer: Cigna Commercial	$2,068.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$537.89
Rate for Payer: Oxford Commercial	$2,068.82
Rate for Payer: Qualcare PPO/HMO/WC	$620.65
Rate for Payer: UnitedHealthcare Commercial	$2,068.82

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$120.25
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$277.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.25
Rate for Payer: Oxford Commercial	$462.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$462.50

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$120.25
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$277.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.25
Rate for Payer: Oxford Commercial	$462.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$462.50

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$2,437.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$2,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$2,250.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$2,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$2,250.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$348.25
Rate for Payer: Aetna Commercial	$208.95
Rate for Payer: Aetna Medicare Advantage	$208.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.61
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.55
Rate for Payer: Oxford Commercial	$348.25
Rate for Payer: Qualcare PPO/HMO/WC	$104.47
Rate for Payer: UnitedHealthcare Commercial	$348.25

CONTROL NASAL HEMORRHAGE, ANT

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	2500364
Hospital Revenue Code	761
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

CONTROL NASAL HEMORRHAGE, ANT

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	2500364
Hospital Revenue Code	761
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$132.74
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.52
Rate for Payer: Oxford Commercial	$221.22
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Commercial	$221.22

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$138.90
Rate for Payer: Aetna Medicare Advantage	$138.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.06
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.19
Rate for Payer: Oxford Commercial	$231.50
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Commercial	$231.50

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$269.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$621.14
Rate for Payer: Aetna Medicare Advantage	$621.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$527.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$527.97
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	$527.97
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.57
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$310.57
Max. Negotiated Rate	$310.57
Rate for Payer: Qualcare PPO/HMO/WC	$310.57

Know your out-of-pocket cost for care.

All Charges