Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLUORESCENT NONINFECT ANTIBODY

Facility

$77.00

Service Code	HCPCS 86255
Hospital Charge Code	3035001A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

FLUORESCITE 10% 5ML

Facility

$387.66

Service Code	NDC 65009265
Hospital Charge Code	606390412
Hospital Revenue Code	250
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$193.83
Rate for Payer: Aetna Commercial	$116.30
Rate for Payer: Aetna Medicare Advantage	$116.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.85
Rate for Payer: Cigna Commercial	$193.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$193.83
Rate for Payer: Qualcare PPO/HMO/WC	$58.15
Rate for Payer: UnitedHealthcare Commercial	$193.83

FLUORESCITE 10% 5ML

Facility

$387.66

Service Code	NDC 65009265
Hospital Charge Code	606390412
Hospital Revenue Code	250
Min. Negotiated Rate	$58.15
Max. Negotiated Rate	$58.15
Rate for Payer: Qualcare PPO/HMO/WC	$58.15

FLUORESCITE 10%/5ML

Facility

$61.00

Hospital Charge Code	60633003
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

FLUORESCITE 10%/5ML

Facility

$61.00

Hospital Charge Code	60633003
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

FLUOR GRID RF ABL BONE-BI

Facility

$6,649.00

Service Code	HCPCS 2099950
Hospital Charge Code	2690320
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-BI

Facility

$6,649.00

Service Code	HCPCS 2099950
Hospital Charge Code	2690320
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-BI

Facility

$6,649.00

Service Code	HCPCS 2099950
Hospital Charge Code	7411772
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-BI

Facility

$6,649.00

Service Code	HCPCS 2099950
Hospital Charge Code	7411772
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	7411863
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	2690920
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	2690920
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	7411863
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	7411864
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	7411864
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	2690925
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	2690925
Hospital Revenue Code	361
Min. Negotiated Rate	$864.37
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$1,994.70
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
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	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$864.37
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR-I-STRIP/9MG/EACH

Facility

$276.00

Hospital Charge Code	60633002
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$82.80
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$138.00

FLUOR-I-STRIP/9MG/EACH

Facility

$276.00

Hospital Charge Code	60633002
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

FLUOR I STRIPS

Facility

$2.00

Hospital Charge Code	60635294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

FLUOR I STRIPS

Facility

$2.00

Hospital Charge Code	60635294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

FLUORO

Facility

$3,032.40

Hospital Charge Code	2009165
Hospital Revenue Code	320
Min. Negotiated Rate	$394.21
Max. Negotiated Rate	$1,516.20
Rate for Payer: Aetna Commercial	$909.72
Rate for Payer: Aetna Medicare Advantage	$909.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$773.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$773.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$773.26
Rate for Payer: Cigna Commercial	$1,516.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$394.21
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$454.86
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FLUORO

Facility

$3,032.40

Hospital Charge Code	2009165
Hospital Revenue Code	320
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Qualcare PPO/HMO/WC	$454.86

Know your out-of-pocket cost for care.

All Charges