Heights University Hospital

All Charges

Charge

Type

Setting

Price

FOLIC ACID 5 MG/ML INJ

Facility

$21.44

Service Code	NDC 63323018410
Hospital Charge Code	6002513
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

FOLIC ACID TAB 1MG

Facility

$1.95

Hospital Charge Code	6023287
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

FOLIC ACID TAB 1MG

Facility

$1.95

Hospital Charge Code	6023287
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

FOLLICLE STIMULATING HORMONE

Facility

$192.85

Service Code	HCPCS 83001
Hospital Charge Code	3001344
Hospital Revenue Code	301
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.20
Rate for Payer: Aetna Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$18.58
Rate for Payer: Cigna Medicare Advantage	$9.29
Rate for Payer: Clover Medicare Advantage	$17.65
Rate for Payer: EmblemHealth Commercial	$55.74
Rate for Payer: Humana Medicare Advantage	$19.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.69
Rate for Payer: Wellcare Medicare Advantage	$18.58

FOLLICLE STIMULATING HORMONE

Facility

$192.85

Service Code	HCPCS 83001
Hospital Charge Code	3001344
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

FOLLOER URET BOUGIE 18 FR

Facility

$551.15

Hospital Charge Code	270664314
Hospital Revenue Code	270
Min. Negotiated Rate	$82.67
Max. Negotiated Rate	$82.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.67

FOLLOER URET BOUGIE 18 FR

Facility

$551.15

Hospital Charge Code	270664314
Hospital Revenue Code	270
Min. Negotiated Rate	$71.65
Max. Negotiated Rate	$275.57
Rate for Payer: Aetna Commercial	$165.34
Rate for Payer: Aetna Medicare Advantage	$165.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.54
Rate for Payer: Cigna Commercial	$275.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.65
Rate for Payer: Oxford Commercial	$275.57
Rate for Payer: Qualcare PPO/HMO/WC	$82.67
Rate for Payer: UnitedHealthcare Commercial	$275.57

FOLLOWER BOUGIE URETERAL 10FR

Facility

$920.00

Hospital Charge Code	270678181
Hospital Revenue Code	272
Min. Negotiated Rate	$119.60
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$276.00
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.60
Rate for Payer: Oxford Commercial	$460.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Commercial	$460.00

FOLLOWER BOUGIE URETERAL 10FR

Facility

$920.00

Hospital Charge Code	270678181
Hospital Revenue Code	272
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

FOLLOWER BOUGIE URETERAL 12FR

Facility

$947.90

Hospital Charge Code	270678182
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER BOUGIE URETERAL 12FR

Facility

$947.90

Hospital Charge Code	270678182
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 14FR

Facility

$947.90

Hospital Charge Code	270678187
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 14FR

Facility

$947.90

Hospital Charge Code	270678187
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER BOUGIE URETERAL 16FR

Facility

$947.90

Hospital Charge Code	270678183
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 16FR

Facility

$947.90

Hospital Charge Code	270678183
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER BOUGIE URETERAL 20FR

Facility

$947.90

Hospital Charge Code	270678184
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER BOUGIE URETERAL 20FR

Facility

$947.90

Hospital Charge Code	270678184
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 22FR

Facility

$947.90

Hospital Charge Code	270678185
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 22FR

Facility

$947.90

Hospital Charge Code	270678185
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER BOUGIE URETERAL 8FR

Facility

$947.90

Hospital Charge Code	270678180
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 8FR

Facility

$947.90

Hospital Charge Code	270678180
Hospital Revenue Code	272
Min. Negotiated Rate	$123.23
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$284.37
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.23
Rate for Payer: Oxford Commercial	$473.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$473.95

FOLLOWER PHILLIPS 10FR

Facility

$716.00

Hospital Charge Code	270600282
Hospital Revenue Code	272
Min. Negotiated Rate	$107.40
Max. Negotiated Rate	$107.40
Rate for Payer: Qualcare PPO/HMO/WC	$107.40

FOLLOWER PHILLIPS 10FR

Facility

$249.80

Hospital Charge Code	270619882
Hospital Revenue Code	272
Min. Negotiated Rate	$32.47
Max. Negotiated Rate	$124.90
Rate for Payer: Aetna Commercial	$74.94
Rate for Payer: Aetna Medicare Advantage	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.70
Rate for Payer: Cigna Commercial	$124.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.47
Rate for Payer: Oxford Commercial	$124.90
Rate for Payer: Qualcare PPO/HMO/WC	$37.47
Rate for Payer: UnitedHealthcare Commercial	$124.90

FOLLOWER PHILLIPS 10FR

Facility

$716.00

Hospital Charge Code	270600282
Hospital Revenue Code	272
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$358.00
Rate for Payer: Aetna Commercial	$214.80
Rate for Payer: Aetna Medicare Advantage	$214.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.58
Rate for Payer: Cigna Commercial	$358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.08
Rate for Payer: Oxford Commercial	$358.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.40
Rate for Payer: UnitedHealthcare Commercial	$358.00

FOLLOWER PHILLIPS 10FR

Facility

$249.80

Hospital Charge Code	270619882
Hospital Revenue Code	272
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$37.47
Rate for Payer: Qualcare PPO/HMO/WC	$37.47

Know your out-of-pocket cost for care.

All Charges