Heights University Hospital

All Charges

Charge

Type

Setting

Price

DIPYRIDAMOLE INJ 50MG/10ML

Facility

$1,224.35

Hospital Charge Code	60627647
Hospital Revenue Code	250
Min. Negotiated Rate	$183.65
Max. Negotiated Rate	$183.65
Rate for Payer: Qualcare PPO/HMO/WC	$183.65

DIPYRIDAMOLE INJ 50MG/10ML

Facility

$1,224.35

Hospital Charge Code	60627647
Hospital Revenue Code	250
Min. Negotiated Rate	$159.17
Max. Negotiated Rate	$612.17
Rate for Payer: Aetna Commercial	$367.31
Rate for Payer: Aetna Medicare Advantage	$367.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.21
Rate for Payer: Cigna Commercial	$612.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.17
Rate for Payer: Oxford Commercial	$612.17
Rate for Payer: Qualcare PPO/HMO/WC	$183.65
Rate for Payer: UnitedHealthcare Commercial	$612.17

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$15.72
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.36
Rate for Payer: Cigna Commercial	$8.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,400.74

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$3,720.22
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,400.74

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

DIRECT COOMBS

Facility

$60.00

Service Code	HCPCS 86880
Hospital Charge Code	3100641
Hospital Revenue Code	300
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

DIRECT COOMBS

Facility

$60.00

Service Code	HCPCS 86880
Hospital Charge Code	3100641
Hospital Revenue Code	300
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$156.52
Max. Negotiated Rate	$756.00
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Aetna Commercial	$361.20
Rate for Payer: Aetna Medicare Advantage	$361.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.52
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$756.00

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

DIRECTED PACKED CELLS

Facility

$896.00

Hospital Charge Code	3100302
Hospital Revenue Code	381
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.40

DIRECTED PACKED CELLS

Facility

$896.00

Hospital Charge Code	3100302
Hospital Revenue Code	381
Min. Negotiated Rate	$116.48
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$268.80
Rate for Payer: Aetna Medicare Advantage	$268.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.48
Rate for Payer: Cigna Commercial	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.48
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.40
Rate for Payer: UnitedHealthcare Commercial	$756.00

DIRECTED WHOLE BLOOD

Facility

$553.65

Hospital Charge Code	3100294
Hospital Revenue Code	382
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$83.05
Rate for Payer: Qualcare PPO/HMO/WC	$83.05

DIRECTED WHOLE BLOOD

Facility

$553.65

Hospital Charge Code	3100294
Hospital Revenue Code	382
Min. Negotiated Rate	$71.97
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$166.09
Rate for Payer: Aetna Medicare Advantage	$166.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.18
Rate for Payer: Cigna Commercial	$276.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.97
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.05
Rate for Payer: UnitedHealthcare Commercial	$756.00

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$219.38
Max. Negotiated Rate	$219.38
Rate for Payer: Qualcare PPO/HMO/WC	$219.38

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$190.12
Max. Negotiated Rate	$731.25
Rate for Payer: Aetna Commercial	$438.75
Rate for Payer: Aetna Medicare Advantage	$438.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.94
Rate for Payer: Cigna Commercial	$731.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.12
Rate for Payer: Oxford Commercial	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$219.38
Rate for Payer: UnitedHealthcare Commercial	$731.25

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.02
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.47
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: Cigna Medicare Advantage	$5.25
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.13
Rate for Payer: Wellcare Medicare Advantage	$10.50

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

DIR-PERC TRANSHEP CHOLANG

Facility

$3,012.00

Hospital Charge Code	2007035
Hospital Revenue Code	320
Min. Negotiated Rate	$391.56
Max. Negotiated Rate	$1,506.00
Rate for Payer: Aetna Commercial	$903.60
Rate for Payer: Aetna Medicare Advantage	$903.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.06
Rate for Payer: Cigna Commercial	$1,506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$451.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges