Heights University Hospital

All Charges

Charge

Type

Setting

Price

HOLTER MONITOR SCAN, RPT, SET

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115012
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74116012
Hospital Revenue Code	731
Min. Negotiated Rate	$54.18
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$125.03
Rate for Payer: Aetna Medicare Advantage	$125.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.28
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.18
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.52
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74117012
Hospital Revenue Code	731
Min. Negotiated Rate	$62.52
Max. Negotiated Rate	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$62.52

HOLTER MONITOR SCAN, RPT, SET

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115012
Hospital Revenue Code	731
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74116012
Hospital Revenue Code	731
Min. Negotiated Rate	$62.52
Max. Negotiated Rate	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$62.52

HOLTER MONITOR SCAN, RPT, SET

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053050
Hospital Revenue Code	731
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

HOLTER MONITOR SCAN, RPT, SET

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053050
Hospital Revenue Code	731
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$145.94
Rate for Payer: Aetna Medicare Advantage	$145.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.04
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.24
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74117012
Hospital Revenue Code	731
Min. Negotiated Rate	$54.18
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$125.03
Rate for Payer: Aetna Medicare Advantage	$125.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.28
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.18
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.52
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SETUP

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053045
Hospital Revenue Code	731
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74117011
Hospital Revenue Code	731
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74117011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74116011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115011
Hospital Revenue Code	731
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	5300041
Hospital Revenue Code	731
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SETUP

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053045
Hospital Revenue Code	731
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$145.94
Rate for Payer: Aetna Medicare Advantage	$145.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.04
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.24
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	5300041
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74116011
Hospital Revenue Code	731
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$1,620.00
Rate for Payer: Aetna Commercial	$1,620.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

HOMATROPINE 2% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60633094
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

HOMATROPINE 2% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60633094
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

HOMATROPINE 2% OPHTH SOLN

Facility

$19.25

Hospital Charge Code	6002789
Hospital Revenue Code	251
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

HOMATROPINE 2% OPHTH SOLN

Facility

$19.25

Hospital Charge Code	6002789
Hospital Revenue Code	251
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

Homatropine 5% oph soln 5ml

Facility

$127.84

Service Code	NDC 59390019205
Hospital Charge Code	6063943293
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

Homatropine 5% oph soln 5ml

Facility

$127.84

Service Code	NDC 59390019205
Hospital Charge Code	6063943293
Hospital Revenue Code	250
Min. Negotiated Rate	$16.62
Max. Negotiated Rate	$63.92
Rate for Payer: Aetna Commercial	$38.35
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$63.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$63.92

HOMATROPINE 5% OPHTH/5ML

Facility

$60.00

Hospital Charge Code	60633095
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

Know your out-of-pocket cost for care.

All Charges