Heights University Hospital

All Charges

Charge

Type

Setting

Price

FBRWIRE3-0 w/Taprd Needle 15MM

Facility

$1,320.00

Hospital Charge Code	270681580
Hospital Revenue Code	272
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$660.00
Rate for Payer: Aetna Commercial	$396.00
Rate for Payer: Aetna Medicare Advantage	$396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$336.60
Rate for Payer: Cigna Commercial	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.60
Rate for Payer: Oxford Commercial	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.00
Rate for Payer: UnitedHealthcare Commercial	$660.00

FBRWIRE3-0 w/Taprd Needle 15MM

Facility

$1,320.00

Hospital Charge Code	270681580
Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.00

FBRWIRE4-0 w/Taprd Needle 12.3

Facility

$110.00

Hospital Charge Code	270681582
Hospital Revenue Code	272
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

FBRWIRE4-0 w/Taprd Needle 12.3

Facility

$110.00

Hospital Charge Code	270681582
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

FCEP F/3.5mm-6.5mm SCR4812-001

Facility

$212.10

Hospital Charge Code	270634937
Hospital Revenue Code	272
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$31.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.82

FCEP F/3.5mm-6.5mm SCR4812-001

Facility

$212.10

Hospital Charge Code	270634937
Hospital Revenue Code	272
Min. Negotiated Rate	$27.57
Max. Negotiated Rate	$106.05
Rate for Payer: Aetna Commercial	$63.63
Rate for Payer: Aetna Medicare Advantage	$63.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.09
Rate for Payer: Cigna Commercial	$106.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.57
Rate for Payer: Oxford Commercial	$106.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.82
Rate for Payer: UnitedHealthcare Commercial	$106.05

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000031
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$899.47
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74117072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501052
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74115072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501022
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74117072
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74115072
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74116072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501052
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000045
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000031
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74116072
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501022
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000045
Hospital Revenue Code	343
Min. Negotiated Rate	$229.87
Max. Negotiated Rate	$899.47
Rate for Payer: Aetna Commercial	$530.46
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$899.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.87
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270703581
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.29
Max. Negotiated Rate	$6,337.62
Rate for Payer: Aetna Commercial	$3,802.57
Rate for Payer: Aetna Medicare Advantage	$3,802.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,232.19
Rate for Payer: Cigna Commercial	$6,337.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270702637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.29
Max. Negotiated Rate	$6,337.62
Rate for Payer: Aetna Commercial	$3,802.57
Rate for Payer: Aetna Medicare Advantage	$3,802.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,232.19
Rate for Payer: Cigna Commercial	$6,337.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270702637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.29
Max. Negotiated Rate	$3,067.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270703581
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.29
Max. Negotiated Rate	$3,067.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29

FDP

Facility

$119.25

Service Code	HCPCS 85362
Hospital Charge Code	3036015
Hospital Revenue Code	305
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.32
Rate for Payer: Aetna Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.24
Rate for Payer: Cigna Commercial	$6.89
Rate for Payer: Cigna Medicare Advantage	$3.44
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.30
Rate for Payer: Wellcare Medicare Advantage	$6.89

Know your out-of-pocket cost for care.

All Charges