Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.02
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$27.00

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$9,552.59

Service Code	APR-DRG 3842
Min. Negotiated Rate	$6,450.38
Max. Negotiated Rate	$9,552.59
Rate for Payer: Aetna Better Health Medicaid	$9,365.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,552.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6,450.38

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$7,683.40

Service Code	APR-DRG 3841
Min. Negotiated Rate	$5,441.51
Max. Negotiated Rate	$7,683.40
Rate for Payer: Aetna Better Health Medicaid	$7,532.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,683.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5,441.51

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$14,048.03

Service Code	APR-DRG 3843
Min. Negotiated Rate	$9,451.21
Max. Negotiated Rate	$14,048.03
Rate for Payer: Aetna Better Health Medicaid	$13,772.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,048.03
Rate for Payer: Wellpoint Medicaid Managed Care	$9,451.21

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$23,911.67

Service Code	APR-DRG 3844
Min. Negotiated Rate	$22,874.87
Max. Negotiated Rate	$23,911.67
Rate for Payer: Aetna Better Health Medicaid	$22,874.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,332.37
Rate for Payer: Wellpoint Medicaid Managed Care	$23,911.67

CONT VISIPAQUE 320 PER 100 ML

Facility

$288.75

Hospital Charge Code	600715
Hospital Revenue Code	636
Min. Negotiated Rate	$43.31
Max. Negotiated Rate	$69.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.31

CONT VISIPAQUE 320 PER 100 ML

Facility

$288.75

Hospital Charge Code	600715
Hospital Revenue Code	636
Min. Negotiated Rate	$43.31
Max. Negotiated Rate	$144.38
Rate for Payer: Aetna Commercial	$86.62
Rate for Payer: Aetna Medicare Advantage	$86.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.63
Rate for Payer: Cigna Commercial	$144.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.31

CONT VISIPAQUE 320 PER 150 ML

Facility

$410.65

Hospital Charge Code	600716
Hospital Revenue Code	636
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.38
Rate for Payer: Qualcare PPO/HMO/WC	$61.60

CONT VISIPAQUE 320 PER 150 ML

Facility

$410.65

Hospital Charge Code	600716
Hospital Revenue Code	636
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$205.32
Rate for Payer: Aetna Commercial	$123.19
Rate for Payer: Aetna Medicare Advantage	$123.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.72
Rate for Payer: Cigna Commercial	$205.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.38
Rate for Payer: Qualcare PPO/HMO/WC	$61.60

CONT VISIPAQUE 320 PER ML (100

Facility

$281.65

Hospital Charge Code	270626139
Hospital Revenue Code	255
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

CONT VISIPAQUE 320 PER ML (100

Facility

$281.65

Hospital Charge Code	270626139
Hospital Revenue Code	255
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

CONVALESCENT PLASMA [EUA]

Facility

$0.01

Service Code	HCPCS P9017
Hospital Charge Code	4025P9017
Hospital Revenue Code	390
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$756.00

CONVALESCENT PLASMA [EUA]

Facility

$0.01

Service Code	HCPCS P9017
Hospital Charge Code	4025P9017
Hospital Revenue Code	390
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CONVENTIONAL INSTRUMENT SET

Facility

$625.00

Hospital Charge Code	270684549
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CONVENTIONAL INSTRUMENT SET

Facility

$625.00

Hospital Charge Code	270684549
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	2011566
Hospital Revenue Code	361
Min. Negotiated Rate	$1,667.55
Max. Negotiated Rate	$8,526.35
Rate for Payer: Aetna Commercial	$3,848.19
Rate for Payer: Aetna Medicare Advantage	$3,848.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,270.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,270.96
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	$3,270.96
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,667.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	411047535
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,526.35
Rate for Payer: Aetna Commercial	$4,366.44
Rate for Payer: Aetna Medicare Advantage	$4,366.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,711.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,711.47
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	$3,711.47
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,892.12
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	7411564
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	2011566
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	2600235
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	7411564
Hospital Revenue Code	361
Min. Negotiated Rate	$1,667.55
Max. Negotiated Rate	$8,526.35
Rate for Payer: Aetna Commercial	$3,848.19
Rate for Payer: Aetna Medicare Advantage	$3,848.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,270.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,270.96
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	$3,270.96
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,667.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	366847535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,183.22
Max. Negotiated Rate	$2,183.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	411047535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,183.22
Max. Negotiated Rate	$2,183.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22

CONVERSION EXT BIL DRG CATH

Facility

$17,259.20

Service Code	HCPCS 47535
Hospital Charge Code	321047535
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,526.35
Rate for Payer: Aetna Commercial	$5,177.76
Rate for Payer: Aetna Medicare Advantage	$5,177.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,401.10
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	$4,401.10
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.70
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

Know your out-of-pocket cost for care.

All Charges