Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$31.44
Rate for Payer: Aetna Medicare Advantage	$31.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.72
Rate for Payer: Cigna Commercial	$52.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$25.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72

FML FORTE 0.25% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633007
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

FML FORTE 0.25% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633007
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$217.08
Rate for Payer: Aetna Commercial	$130.25
Rate for Payer: Aetna Medicare Advantage	$130.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.71
Rate for Payer: Cigna Commercial	$217.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.44
Rate for Payer: Oxford Commercial	$217.08
Rate for Payer: Qualcare PPO/HMO/WC	$65.12
Rate for Payer: UnitedHealthcare Commercial	$217.08

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$65.12
Rate for Payer: Qualcare PPO/HMO/WC	$65.12

FML S.O.P. 0.1%/3.5GM

Facility

$84.00

Hospital Charge Code	60633009
Hospital Revenue Code	250
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.92
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$42.00

FML S.O.P. 0.1%/3.5GM

Facility

$84.00

Hospital Charge Code	60633009
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

FML-S OPHTHALMIC SOLUTION

Facility

$51.00

Hospital Charge Code	60634915
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

FML-S OPHTHALMIC SOLUTION

Facility

$51.00

Hospital Charge Code	60634915
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

FMRAL PS72.5 LFT OPN BX 184533

Facility

$17,230.00

Hospital Charge Code	270655090
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$5,169.00
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FMRAL PS72.5 LFT OPN BX 184533

Facility

$17,230.00

Hospital Charge Code	270655090
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FMRL SEG OSS RS RIGHT

Facility

$61,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270691621
Hospital Revenue Code	278
Min. Negotiated Rate	$9,213.00
Max. Negotiated Rate	$14,863.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,863.64
Rate for Payer: Qualcare PPO/HMO/WC	$9,213.00

FMRL SEG OSS RS RIGHT

Facility

$61,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270691621
Hospital Revenue Code	278
Min. Negotiated Rate	$9,213.00
Max. Negotiated Rate	$30,710.00
Rate for Payer: Aetna Commercial	$18,426.00
Rate for Payer: Aetna Medicare Advantage	$18,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,662.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,662.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,662.10
Rate for Payer: Cigna Commercial	$30,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,863.64
Rate for Payer: Qualcare PPO/HMO/WC	$9,213.00

FNA BIOPSY/CT 1ST LESION

Facility

$9,500.00

Service Code	HCPCS 10009
Hospital Charge Code	404310009
Hospital Revenue Code	361
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

FNA BIOPSY/CT 1ST LESION

Facility

$9,500.00

Service Code	HCPCS 10009
Hospital Charge Code	404310009
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

FNA BIOPSY/CT EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10010
Hospital Charge Code	404310010
Hospital Revenue Code	361
Min. Negotiated Rate	$70.47
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$70.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

FNA BIOPSY/CT EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10010
Hospital Charge Code	404310010
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	321010007
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	411010007
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	411010007
Hospital Revenue Code	361
Min. Negotiated Rate	$441.55
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,018.97
Rate for Payer: Aetna Medicare Advantage	$1,018.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.12
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	$866.12
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.55
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	321010007
Hospital Revenue Code	361
Min. Negotiated Rate	$441.55
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,018.97
Rate for Payer: Aetna Medicare Advantage	$1,018.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.12
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	$866.12
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.55
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	404610007
Hospital Revenue Code	361
Min. Negotiated Rate	$441.55
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,018.97
Rate for Payer: Aetna Medicare Advantage	$1,018.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.12
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	$866.12
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.55
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	404610007
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

FNA BIOPSY/FLUORO EA ADD LES

Facility

$1,698.28

Service Code	HCPCS 10008
Hospital Charge Code	321010008
Hospital Revenue Code	361
Min. Negotiated Rate	$254.74
Max. Negotiated Rate	$254.74
Rate for Payer: Qualcare PPO/HMO/WC	$254.74

Know your out-of-pocket cost for care.

All Charges