Heights University Hospital

All Charges

Charge

Type

Setting

Price

HYSTEROSY,W BX ENDOM /POLYPECT

Facility

$20,944.30

Service Code	HCPCS 58558
Hospital Charge Code	16000762
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$6,283.29
Rate for Payer: Aetna Medicare Advantage	$6,283.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,340.80
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	$5,340.80
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.76
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

HYSTEROSY,W BX ENDOM /POLYPECT

Facility

$20,944.30

Service Code	HCPCS 58558
Hospital Charge Code	16000762
Hospital Revenue Code	360
Min. Negotiated Rate	$3,141.64
Max. Negotiated Rate	$3,141.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64

HYSTRCPY;W LYSIS INTRAUT ADHSN

Facility

$20,944.30

Service Code	HCPCS 58559
Hospital Charge Code	1600000653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,141.64
Max. Negotiated Rate	$3,141.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64

HYSTRCPY;W LYSIS INTRAUT ADHSN

Facility

$20,944.30

Service Code	HCPCS 58559
Hospital Charge Code	1600000653
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,912.81
Rate for Payer: Aetna Commercial	$6,283.29
Rate for Payer: Aetna Medicare Advantage	$6,283.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,340.80
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	$5,340.80
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.76
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

HYTAHEROLDIOPS/15ML

Facility

$290.00

Hospital Charge Code	60634577
Hospital Revenue Code	250
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

HYTAHEROLDIOPS/15ML

Facility

$290.00

Hospital Charge Code	60634577
Hospital Revenue Code	250
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$87.00
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$145.00

HY-TAPE ZIN 1

Facility

$14.55

Hospital Charge Code	270302218
Hospital Revenue Code	270
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$7.28
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna Medicare Advantage	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$7.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$7.28

HY-TAPE ZIN 1

Facility

$14.55

Hospital Charge Code	270302218
Hospital Revenue Code	270
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

HYTONE 2.5%/60ML

Facility

$95.00

Hospital Charge Code	60633144
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

HYTONE 2.5%/60ML

Facility

$95.00

Hospital Charge Code	60633144
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

HYTRIN/10MG/TAB

Facility

$10.72

Service Code	NDC 781205401
Hospital Charge Code	60634839
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$3.22
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.73
Rate for Payer: Cigna Commercial	$5.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$5.36

HYTRIN/10MG/TAB

Facility

$10.72

Service Code	NDC 781205401
Hospital Charge Code	60634839
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

HYTRIN/1MG/UD

Facility

$10.79

Service Code	NDC 51079093720
Hospital Charge Code	60634630
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$5.39

HYTRIN/1MG/UD

Facility

$10.79

Service Code	NDC 51079093720
Hospital Charge Code	60634630
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

HYTRIN/5MG/TAB

Facility

$7.00

Hospital Charge Code	60634838
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

HYTRIN/5MG/TAB

Facility

$7.00

Hospital Charge Code	60634838
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

I-123 PER UNIT OF 100UCI

Facility

$193.83

Service Code	HCPCS A9516
Hospital Charge Code	4509075
Hospital Revenue Code	343
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$29.07
Rate for Payer: Qualcare PPO/HMO/WC	$29.07

I-123 PER UNIT OF 100UCI

Facility

$193.83

Service Code	HCPCS A9516
Hospital Charge Code	4509075
Hospital Revenue Code	343
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$96.92
Rate for Payer: Aetna Commercial	$58.15
Rate for Payer: Aetna Medicare Advantage	$58.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.43
Rate for Payer: Cigna Commercial	$96.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$29.07

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$118.73
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$118.73
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$76.37
Rate for Payer: Aetna Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.36
Rate for Payer: Cigna Commercial	$23.57
Rate for Payer: Cigna Medicare Advantage	$11.79
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24.98
Rate for Payer: Wellcare Medicare Advantage	$23.57

IABP INSERTION PERC

Facility

$4,732.00

Service Code	HCPCS 33967
Hospital Charge Code	5100086
Hospital Revenue Code	481
Min. Negotiated Rate	$709.80
Max. Negotiated Rate	$709.80
Rate for Payer: Qualcare PPO/HMO/WC	$709.80

Know your out-of-pocket cost for care.

All Charges