Heights University Hospital

All Charges

Charge

Type

Setting

Price

FINGER TRAP X-SMALL

Facility

$91.57

Hospital Charge Code	270677422
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FINGER TRAP X-SMALL

Facility

$91.57

Hospital Charge Code	270677422
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$27.47
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.90
Rate for Payer: Oxford Commercial	$45.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$45.78

FIORICET 300-50-40MG CAPSULE

Facility

$32.23

Service Code	NDC 70010004401
Hospital Charge Code	606390541
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.83

FIORICET 300-50-40MG CAPSULE

Facility

$32.23

Service Code	NDC 70010004401
Hospital Charge Code	606390541
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$16.11
Rate for Payer: Aetna Commercial	$9.67
Rate for Payer: Aetna Medicare Advantage	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.22
Rate for Payer: Cigna Commercial	$16.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.19
Rate for Payer: Oxford Commercial	$16.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.83
Rate for Payer: UnitedHealthcare Commercial	$16.11

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

FIORICET/TAB

Facility

$3.00

Hospital Charge Code	60632991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

FIORICET/TAB

Facility

$3.00

Hospital Charge Code	60632991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FIOS SCREW 4X40MM

Facility

$1,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270703681
Hospital Revenue Code	279
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00

FIOS SCREW 4X40MM

Facility

$1,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270703681
Hospital Revenue Code	279
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$880.00
Rate for Payer: Aetna Commercial	$528.00
Rate for Payer: Aetna Medicare Advantage	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.80
Rate for Payer: Cigna Commercial	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.80
Rate for Payer: Oxford Commercial	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.00
Rate for Payer: UnitedHealthcare Commercial	$880.00

FIRST TMT PLATE

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270686491
Hospital Revenue Code	278
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$429.68
Rate for Payer: Aetna Commercial	$257.81
Rate for Payer: Aetna Medicare Advantage	$257.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.13
Rate for Payer: Cigna Commercial	$429.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: Qualcare PPO/HMO/WC	$128.90

FIRST TMT PLATE

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270686491
Hospital Revenue Code	278
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$207.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: Qualcare PPO/HMO/WC	$128.90

FIRST TRIMESTER SCREEN W/NT I

Facility

$103.50

Service Code	HCPCS 84163
Hospital Charge Code	3038512A
Hospital Revenue Code	300
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

FIRST TRIMESTER SCREEN W/NT I

Facility

$103.50

Service Code	HCPCS 84163
Hospital Charge Code	3038512A
Hospital Revenue Code	300
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

FIRST TRIMESTER SCREEN W/NT II

Facility

$633.00

Service Code	HCPCS 84702
Hospital Charge Code	3038512B
Hospital Revenue Code	300
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

FIRST TRIMESTER SCREEN W/NT II

Facility

$633.00

Service Code	HCPCS 84702
Hospital Charge Code	3038512B
Hospital Revenue Code	300
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

FIRST TRIMESTER SCREN W/NT III

Facility

$97.00

Service Code	HCPCS 86336
Hospital Charge Code	3038512C
Hospital Revenue Code	300
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.51
Rate for Payer: Aetna Medicare Advantage	$15.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$15.59
Rate for Payer: Cigna Medicare Advantage	$7.79
Rate for Payer: Clover Medicare Advantage	$14.81
Rate for Payer: EmblemHealth Commercial	$46.77
Rate for Payer: Humana Medicare Advantage	$16.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.59
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.53
Rate for Payer: Wellcare Medicare Advantage	$15.59

FIRST TRIMESTER SCREN W/NT III

Facility

$97.00

Service Code	HCPCS 86336
Hospital Charge Code	3038512C
Hospital Revenue Code	300
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

FIRVANQ 50MG/ML SUSP

Facility

$36.18

Service Code	NDC 65628020605
Hospital Charge Code	606390239
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$18.09

FIRVANQ 50MG/ML SUSP

Facility

$36.18

Service Code	NDC 65628020605
Hospital Charge Code	606390239
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

FISH DISPOSABLE

Facility

$115.70

Hospital Charge Code	270650902
Hospital Revenue Code	271
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$17.36
Rate for Payer: Qualcare PPO/HMO/WC	$17.36

FISH DISPOSABLE

Facility

$115.70

Hospital Charge Code	270650902
Hospital Revenue Code	271
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$57.85
Rate for Payer: Aetna Commercial	$34.71
Rate for Payer: Aetna Medicare Advantage	$34.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.50
Rate for Payer: Cigna Commercial	$57.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.04
Rate for Payer: Oxford Commercial	$57.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.36
Rate for Payer: UnitedHealthcare Commercial	$57.85

FISH DISPOSABLE VISCERAL LRG

Facility

$243.37

Hospital Charge Code	270653825
Hospital Revenue Code	272
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$121.69
Rate for Payer: Aetna Commercial	$73.01
Rate for Payer: Aetna Medicare Advantage	$73.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.06
Rate for Payer: Cigna Commercial	$121.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.64
Rate for Payer: Oxford Commercial	$121.69
Rate for Payer: Qualcare PPO/HMO/WC	$36.51
Rate for Payer: UnitedHealthcare Commercial	$121.69

Know your out-of-pocket cost for care.

All Charges