Heights University Hospital

All Charges

Charge

Type

Setting

Price

FHC REFER LAB-OTHER

Facility

$246.45

Service Code	HCPCS 84999EP
Hospital Charge Code	9400091
Hospital Revenue Code	301
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$123.22
Rate for Payer: Aetna Commercial	$73.94
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$114.00

FHC SUBSEQUENT HEALTHSTART VS

Facility

$248.75

Service Code	HCPCS 99241
Hospital Charge Code	9400078
Hospital Revenue Code	510
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$124.38
Rate for Payer: Aetna Commercial	$74.62
Rate for Payer: Aetna Medicare Advantage	$74.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.43
Rate for Payer: Cigna Commercial	$124.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.34
Rate for Payer: Qualcare PPO/HMO/WC	$37.31

FHC SUBSEQUENT HEALTHSTART VS

Facility

$248.75

Service Code	HCPCS 99241
Hospital Charge Code	9400078
Hospital Revenue Code	510
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$37.31
Rate for Payer: Qualcare PPO/HMO/WC	$37.31

FHC SUBSEQUENT HEALTHSTRT VSII

Facility

$270.00

Service Code	HCPCS 99241
Hospital Charge Code	9400086
Hospital Revenue Code	510
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

FHC SUBSEQUENT HEALTHSTRT VSII

Facility

$270.00

Service Code	HCPCS 99241
Hospital Charge Code	9400086
Hospital Revenue Code	510
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

FHC VENI-CAPILLARY(LEAD SCRN)

Facility

$160.00

Service Code	HCPCS 3641659
Hospital Charge Code	9400088
Hospital Revenue Code	300
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC VENI-CAPILLARY(LEAD SCRN)

Facility

$160.00

Service Code	HCPCS 3641659
Hospital Charge Code	9400088
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

FHC VENI-CAPILLARY (OTHER)

Facility

$160.00

Service Code	HCPCS 36416
Hospital Charge Code	9400089
Hospital Revenue Code	300
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

FHC VENI-CAPILLARY (OTHER)

Facility

$160.00

Service Code	HCPCS 36416
Hospital Charge Code	9400089
Hospital Revenue Code	300
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC VISION REFERRAL

Facility

$220.00

Service Code	HCPCS 92499EP
Hospital Charge Code	9400097
Hospital Revenue Code	510
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

FHC VISION REFERRAL

Facility

$220.00

Service Code	HCPCS 92499EP
Hospital Charge Code	9400097
Hospital Revenue Code	510
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

FIBER BAR GLASS 11MM X 150MM

Facility

$887.75

Hospital Charge Code	270668709
Hospital Revenue Code	278
Min. Negotiated Rate	$133.16
Max. Negotiated Rate	$214.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.84
Rate for Payer: Qualcare PPO/HMO/WC	$133.16

FIBER BAR GLASS 11MM X 150MM

Facility

$887.75

Hospital Charge Code	270668709
Hospital Revenue Code	278
Min. Negotiated Rate	$133.16
Max. Negotiated Rate	$443.88
Rate for Payer: Aetna Commercial	$266.32
Rate for Payer: Aetna Medicare Advantage	$266.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.38
Rate for Payer: Cigna Commercial	$443.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.84
Rate for Payer: Qualcare PPO/HMO/WC	$133.16

FIBER BAR GLASS 11MM X 350MM

Facility

$1,155.75

Hospital Charge Code	270668710
Hospital Revenue Code	278
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$279.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.69
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

FIBER BAR GLASS 11MM X 350MM

Facility

$1,155.75

Hospital Charge Code	270668710
Hospital Revenue Code	278
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$577.88
Rate for Payer: Aetna Commercial	$346.73
Rate for Payer: Aetna Medicare Advantage	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.72
Rate for Payer: Cigna Commercial	$577.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.69
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

FIBER BONE GRAFT STAGRAFT 5CC

Facility

$11,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270700039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,702.50
Max. Negotiated Rate	$2,746.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,746.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.50

FIBER BONE GRAFT STAGRAFT 5CC

Facility

$11,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270700039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,702.50
Max. Negotiated Rate	$5,675.00
Rate for Payer: Aetna Commercial	$3,405.00
Rate for Payer: Aetna Medicare Advantage	$3,405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,894.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,894.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,894.25
Rate for Payer: Cigna Commercial	$5,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,746.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.50

FIBER DISC

Facility

$10,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270692240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$2,516.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,560.00

FIBER DISC

Facility

$10,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270692240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$5,200.00
Rate for Payer: Aetna Commercial	$3,120.00
Rate for Payer: Aetna Medicare Advantage	$3,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,652.00
Rate for Payer: Cigna Commercial	$5,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,560.00

FIBER GREENLIGHT

Facility

$5,000.00

Hospital Charge Code	270683514
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

FIBER GREENLIGHT

Facility

$5,000.00

Hospital Charge Code	270683514
Hospital Revenue Code	272
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

FIBER GREEN LIGHT MOXY REF#10

Facility

$5,000.00

Hospital Charge Code	270675695
Hospital Revenue Code	279
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

FIBER GREEN LIGHT MOXY REF#10

Facility

$5,000.00

Hospital Charge Code	270675695
Hospital Revenue Code	279
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

FIBER HOLMION 356 MICRON

Facility

$5,250.00

Hospital Charge Code	270675974
Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FIBER HOLMION 356 MICRON

Facility

$5,250.00

Hospital Charge Code	270675974
Hospital Revenue Code	272
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

Know your out-of-pocket cost for care.

All Charges