Heights University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL V ESTAB. 40 MINS

Facility

$1,048.92

Service Code	HCPCS 99215
Hospital Charge Code	87504125
Hospital Revenue Code	513
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

E&M LEVEL V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$192.44
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$263.30
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.09
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V NP 60 MINS

Facility

$183.00

Service Code	HCPCS 99205
Hospital Charge Code	94810210
Hospital Revenue Code	915
Min. Negotiated Rate	$23.79
Max. Negotiated Rate	$189.03
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: Aetna Medicare Advantage	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.66
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.79
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

E&M LEVEL V NP 60 MINS

Facility

$183.00

Service Code	HCPCS 99205
Hospital Charge Code	94810210
Hospital Revenue Code	915
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

E&M LVL III EST PT 15 MINS

Facility

$1,017.00

Service Code	HCPCS 99213
Hospital Charge Code	94810225
Hospital Revenue Code	513
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$305.10
Rate for Payer: Aetna Commercial	$305.10
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.21
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

E&M LVL III EST PT 15 MINS

Facility

$1,017.00

Service Code	HCPCS 99213
Hospital Charge Code	94810225
Hospital Revenue Code	513
Min. Negotiated Rate	$152.55
Max. Negotiated Rate	$152.55
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

E&M LVL IV EST PAT 25 MINS

Facility

$1,879.97

Service Code	HCPCS 99214
Hospital Charge Code	94810230
Hospital Revenue Code	513
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

E&M LVL IV EST PAT 25 MINS

Facility

$1,879.97

Service Code	HCPCS 99214
Hospital Charge Code	94810230
Hospital Revenue Code	513
Min. Negotiated Rate	$91.37
Max. Negotiated Rate	$563.99
Rate for Payer: Aetna Commercial	$563.99
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.40
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

E&M LVL V EST PAT 40 MINS

Facility

$408.00

Service Code	HCPCS 99215
Hospital Charge Code	94810235
Hospital Revenue Code	915
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.20

E&M LVL V EST PAT 40 MINS

Facility

$408.00

Service Code	HCPCS 99215
Hospital Charge Code	94810235
Hospital Revenue Code	915
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$241.59
Rate for Payer: Aetna Commercial	$122.40
Rate for Payer: Aetna Medicare Advantage	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.04
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.04
Rate for Payer: Qualcare PPO/HMO/WC	$61.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24

EMPTY EVAC CONTAINER250ML

Facility

$302.00

Hospital Charge Code	60635678
Hospital Revenue Code	250
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$151.00
Rate for Payer: Aetna Commercial	$90.60
Rate for Payer: Aetna Medicare Advantage	$90.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.01
Rate for Payer: Cigna Commercial	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$151.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$151.00

EMPTY EVAC CONTAINER250ML

Facility

$302.00

Hospital Charge Code	60635678
Hospital Revenue Code	250
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$211.78
Max. Negotiated Rate	$814.52
Rate for Payer: Aetna Commercial	$488.71
Rate for Payer: Aetna Medicare Advantage	$488.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.41
Rate for Payer: Cigna Commercial	$814.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.78
Rate for Payer: Oxford Commercial	$814.52
Rate for Payer: Qualcare PPO/HMO/WC	$244.36
Rate for Payer: UnitedHealthcare Commercial	$814.52

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$244.36
Max. Negotiated Rate	$244.36
Rate for Payer: Qualcare PPO/HMO/WC	$244.36

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,250.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$20.18

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$17.49
Max. Negotiated Rate	$67.27
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Aetna Medicare Advantage	$40.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.31
Rate for Payer: Cigna Commercial	$67.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.49
Rate for Payer: Oxford Commercial	$67.27
Rate for Payer: Qualcare PPO/HMO/WC	$20.18
Rate for Payer: UnitedHealthcare Commercial	$67.27

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$51.59
Rate for Payer: Qualcare PPO/HMO/WC	$51.59

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$44.71
Max. Negotiated Rate	$171.96
Rate for Payer: Aetna Commercial	$103.17
Rate for Payer: Aetna Medicare Advantage	$103.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.70
Rate for Payer: Cigna Commercial	$171.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.71
Rate for Payer: Oxford Commercial	$171.96
Rate for Payer: Qualcare PPO/HMO/WC	$51.59
Rate for Payer: UnitedHealthcare Commercial	$171.96

Know your out-of-pocket cost for care.

All Charges