Heights University Hospital

All Charges

Charge

Type

Setting

Price

AMMONIUM CHLORIDE/5MEQ/1M

Facility

$830.00

Hospital Charge Code	60632447
Hospital Revenue Code	250
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$38.49
Rate for Payer: Qualcare PPO/HMO/WC	$38.49

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$33.36
Max. Negotiated Rate	$128.31
Rate for Payer: Aetna Commercial	$76.98
Rate for Payer: Aetna Medicare Advantage	$76.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.44
Rate for Payer: Cigna Commercial	$128.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.36
Rate for Payer: Oxford Commercial	$128.31
Rate for Payer: Qualcare PPO/HMO/WC	$38.49
Rate for Payer: UnitedHealthcare Commercial	$128.31

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$40.37
Rate for Payer: Aetna Commercial	$24.22
Rate for Payer: Aetna Medicare Advantage	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.59
Rate for Payer: Cigna Commercial	$40.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$40.37
Rate for Payer: Qualcare PPO/HMO/WC	$12.11
Rate for Payer: UnitedHealthcare Commercial	$40.37

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$12.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.11

AMMONIUM LACTATE LOT 5%

Facility

$13.65

Hospital Charge Code	60628450
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

AMMONIUM LACTATE LOT 5%

Facility

$13.65

Hospital Charge Code	60628450
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

AMNI-HOOK STERILE DISP

Facility

$8.50

Hospital Charge Code	270650233
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

AMNI-HOOK STERILE DISP

Facility

$8.50

Hospital Charge Code	270650233
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$4.25
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.17
Rate for Payer: Cigna Commercial	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.27
Rate for Payer: UnitedHealthcare Commercial	$4.25

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,204.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$38.23
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$361.20
Rate for Payer: Aetna Medicare Advantage	$361.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.02
Rate for Payer: Cigna Commercial	$38.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.52
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,204.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	83653215
Hospital Revenue Code	402
Min. Negotiated Rate	$38.23
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$38.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.54
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$38.23
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$257.40
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$38.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.54
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	83653215
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$84.43
Max. Negotiated Rate	$2,979.00
Rate for Payer: Aetna Commercial	$444.00
Rate for Payer: Aetna Medicare Advantage	$444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.40
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.40
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Commercial	$2,979.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$84.43
Max. Negotiated Rate	$2,193.38
Rate for Payer: Aetna Commercial	$444.00
Rate for Payer: Aetna Medicare Advantage	$444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.40
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.40
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,090.50
Rate for Payer: Aetna Commercial	$4,090.50
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$1,899.97
Max. Negotiated Rate	$3,065.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$1,899.97
Max. Negotiated Rate	$6,333.25
Rate for Payer: Aetna Commercial	$3,799.95
Rate for Payer: Aetna Medicare Advantage	$3,799.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,229.96
Rate for Payer: Cigna Commercial	$6,333.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97

Know your out-of-pocket cost for care.

All Charges