Heights University Hospital

All Charges

Charge

Type

Setting

Price

EVEROLIMUS,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80169
Hospital Charge Code	401180169
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EV FEMPOP ARTL REVASC

Facility

$61,839.20

Service Code	HCPCS 0505T
Hospital Charge Code	41100505T
Hospital Revenue Code	360
Min. Negotiated Rate	$9,275.88
Max. Negotiated Rate	$9,275.88
Rate for Payer: Qualcare PPO/HMO/WC	$9,275.88

EV FEMPOP ARTL REVASC

Facility

$61,839.20

Service Code	HCPCS 0505T
Hospital Charge Code	41100505T
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$18,551.76
Rate for Payer: Aetna Medicare Advantage	$18,551.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,769.00
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	$15,769.00
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,039.10
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,275.88
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

EVICEL FIBRIN SEALANT

Facility

$3,400.00

Hospital Charge Code	270666998
Hospital Revenue Code	270
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

EVICEL FIBRIN SEALANT

Facility

$3,400.00

Hospital Charge Code	270666998
Hospital Revenue Code	270
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,020.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00

EVICEL TIP RIGID 35 CM

Facility

$259.50

Hospital Charge Code	270667032
Hospital Revenue Code	270
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$38.92
Rate for Payer: Qualcare PPO/HMO/WC	$38.92

EVICEL TIP RIGID 35 CM

Facility

$259.50

Hospital Charge Code	270667032
Hospital Revenue Code	270
Min. Negotiated Rate	$33.73
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$77.85
Rate for Payer: Aetna Medicare Advantage	$77.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.17
Rate for Payer: Cigna Commercial	$129.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.73
Rate for Payer: Oxford Commercial	$129.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.92
Rate for Payer: UnitedHealthcare Commercial	$129.75

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$174.28
Max. Negotiated Rate	$174.28
Rate for Payer: Qualcare PPO/HMO/WC	$174.28

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$151.04
Max. Negotiated Rate	$580.94
Rate for Payer: Aetna Commercial	$348.56
Rate for Payer: Aetna Medicare Advantage	$348.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.28
Rate for Payer: Cigna Commercial	$580.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.04
Rate for Payer: Oxford Commercial	$580.94
Rate for Payer: Qualcare PPO/HMO/WC	$174.28
Rate for Payer: UnitedHealthcare Commercial	$580.94

EVOGRAFT DBM FIBERS 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694132
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

EVOGRAFT DBM FIBERS 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694132
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$4,800.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3082M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3037M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3050M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3034M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3046M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3121M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3500M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	4229M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3048M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3046M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3248M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3080M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$225.75
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$103.00

Know your out-of-pocket cost for care.

All Charges