Heights University Hospital

All Charges

Charge

Type

Setting

Price

FOLLOWER PHILLIPS 12FR

Facility

$249.80

Hospital Charge Code	270600148
Hospital Revenue Code	272
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$37.47
Rate for Payer: Qualcare PPO/HMO/WC	$37.47

FOLLOWER PHILLIPS 12FR

Facility

$621.65

Hospital Charge Code	270600279
Hospital Revenue Code	272
Min. Negotiated Rate	$80.81
Max. Negotiated Rate	$310.82
Rate for Payer: Aetna Commercial	$186.50
Rate for Payer: Aetna Medicare Advantage	$186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.52
Rate for Payer: Cigna Commercial	$310.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.81
Rate for Payer: Oxford Commercial	$310.82
Rate for Payer: Qualcare PPO/HMO/WC	$93.25
Rate for Payer: UnitedHealthcare Commercial	$310.82

FOLLOWER PHILLIPS 12FR

Facility

$249.80

Hospital Charge Code	270600148
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 12FR

Facility

$621.65

Hospital Charge Code	270600279
Hospital Revenue Code	272
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$93.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.25

FOLLOWER PHILLIPS 14FR

Facility

$249.80

Hospital Charge Code	270600284
Hospital Revenue Code	272
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$37.47
Rate for Payer: Qualcare PPO/HMO/WC	$37.47

FOLLOWER PHILLIPS 14FR

Facility

$249.80

Hospital Charge Code	270600284
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 16FR

Facility

$252.20

Hospital Charge Code	270600150
Hospital Revenue Code	272
Min. Negotiated Rate	$37.83
Max. Negotiated Rate	$37.83
Rate for Payer: Qualcare PPO/HMO/WC	$37.83

FOLLOWER PHILLIPS 16FR

Facility

$252.20

Hospital Charge Code	270600150
Hospital Revenue Code	272
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Commercial	$75.66
Rate for Payer: Aetna Medicare Advantage	$75.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.31
Rate for Payer: Cigna Commercial	$126.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.79
Rate for Payer: Oxford Commercial	$126.10
Rate for Payer: Qualcare PPO/HMO/WC	$37.83
Rate for Payer: UnitedHealthcare Commercial	$126.10

FOLLOWER PHILLIPS 18FR

Facility

$252.20

Hospital Charge Code	270600285
Hospital Revenue Code	272
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Commercial	$75.66
Rate for Payer: Aetna Medicare Advantage	$75.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.31
Rate for Payer: Cigna Commercial	$126.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.79
Rate for Payer: Oxford Commercial	$126.10
Rate for Payer: Qualcare PPO/HMO/WC	$37.83
Rate for Payer: UnitedHealthcare Commercial	$126.10

FOLLOWER PHILLIPS 18FR

Facility

$252.20

Hospital Charge Code	270600285
Hospital Revenue Code	272
Min. Negotiated Rate	$37.83
Max. Negotiated Rate	$37.83
Rate for Payer: Qualcare PPO/HMO/WC	$37.83

FOLLOWER PHILLIPS 8FR

Facility

$249.80

Hospital Charge Code	270600280
Hospital Revenue Code	272
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$37.47
Rate for Payer: Qualcare PPO/HMO/WC	$37.47

FOLLOWER PHILLIPS 8FR

Facility

$249.80

Hospital Charge Code	270600280
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

FOLLOWUP ENHANCED COUNSELING**

Facility

$30.00

Service Code	HCPCS Y7634WF
Hospital Charge Code	9600017
Hospital Revenue Code	519
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

FOLLOWUP ENHANCED COUNSELING**

Facility

$30.00

Service Code	HCPCS Y7634WF
Hospital Charge Code	9600017
Hospital Revenue Code	519
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

FOLLOWUP HOSP CARE 15MINS

Facility

$350.00

Service Code	HCPCS 99231
Hospital Charge Code	83246210
Hospital Revenue Code	919
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$47.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 15MINS

Facility

$350.00

Service Code	HCPCS 99231
Hospital Charge Code	83246210
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 25MINS

Facility

$350.00

Service Code	HCPCS 99232
Hospital Charge Code	83246215
Hospital Revenue Code	919
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$76.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 25MINS

Facility

$350.00

Service Code	HCPCS 99232
Hospital Charge Code	83246215
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 35MINS

Facility

$350.00

Service Code	HCPCS 99233
Hospital Charge Code	83246220
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLLOWUP HOSP CARE 35MINS

Facility

$350.00

Service Code	HCPCS 99233
Hospital Charge Code	83246220
Hospital Revenue Code	919
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$115.66
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$115.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

FOLVITE/5MG/1ML

Facility

$90.00

Hospital Charge Code	60633012
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

FOLVITE/5MG/1ML

Facility

$90.00

Hospital Charge Code	60633012
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

FOMEPIZOLE 1 GM/ML INJ

Facility

$9,144.50

Service Code	HCPCS J1451
Hospital Charge Code	60629078
Hospital Revenue Code	636
Min. Negotiated Rate	$1,371.67
Max. Negotiated Rate	$2,743.35
Rate for Payer: Aetna Commercial	$2,743.35
Rate for Payer: Aetna Medicare Advantage	$2,743.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,331.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,331.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,331.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.67

FOMEPIZOLE 1 GM/ML INJ

Facility

$9,144.50

Service Code	HCPCS J1451
Hospital Charge Code	60629078
Hospital Revenue Code	636
Min. Negotiated Rate	$1,371.67
Max. Negotiated Rate	$2,212.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.67

FONDAPARINUX SODIUM 7.5 MG SYR

Facility

$9,378.45

Hospital Charge Code	60630049
Hospital Revenue Code	250
Min. Negotiated Rate	$1,406.77
Max. Negotiated Rate	$1,406.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.77

Know your out-of-pocket cost for care.

All Charges