Heights University Hospital

All Charges

Charge

Type

Setting

Price

IDET 1 OR MORE LEVELS

Facility

$4,410.00

Service Code	HCPCS 22527
Hospital Charge Code	7411359
Hospital Revenue Code	361
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$661.50
Rate for Payer: Qualcare PPO/HMO/WC	$661.50

IDET 1 OR MORE LEVELS

Facility

$4,410.00

Service Code	HCPCS 22527
Hospital Charge Code	7411359
Hospital Revenue Code	361
Min. Negotiated Rate	$573.30
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,323.00
Rate for Payer: Aetna Medicare Advantage	$1,323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.55
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	$1,124.55
Rate for Payer: Cigna Commercial	$2,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$573.30
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$661.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IDET SINGLE LEVEL

Facility

$4,410.00

Service Code	HCPCS 22526
Hospital Charge Code	2690015
Hospital Revenue Code	361
Min. Negotiated Rate	$573.30
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,323.00
Rate for Payer: Aetna Medicare Advantage	$1,323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.55
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	$1,124.55
Rate for Payer: Cigna Commercial	$2,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$573.30
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$661.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IDET SINGLE LEVEL

Facility

$4,410.00

Service Code	HCPCS 22526
Hospital Charge Code	2690015
Hospital Revenue Code	361
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$661.50
Rate for Payer: Qualcare PPO/HMO/WC	$661.50

IDET SINGLE LEVEL

Facility

$4,410.00

Service Code	HCPCS 22526
Hospital Charge Code	7411358
Hospital Revenue Code	361
Min. Negotiated Rate	$573.30
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,323.00
Rate for Payer: Aetna Medicare Advantage	$1,323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,124.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,124.55
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	$1,124.55
Rate for Payer: Cigna Commercial	$2,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$573.30
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$661.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IDET SINGLE LEVEL

Facility

$4,410.00

Service Code	HCPCS 22526
Hospital Charge Code	7411358
Hospital Revenue Code	361
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$661.50
Rate for Payer: Qualcare PPO/HMO/WC	$661.50

IDET,SINGLE LEVEL--LT

Facility

$30,000.00

Service Code	HCPCS 22526
Hospital Charge Code	16000800
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$9,000.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
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	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,900.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

IDET,SINGLE LEVEL--LT

Facility

$30,000.00

Service Code	HCPCS 22526
Hospital Charge Code	16000800
Hospital Revenue Code	360
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

I&D EYELID ABSCESS

Facility

$1,578.95

Service Code	HCPCS 67700
Hospital Charge Code	5780250
Hospital Revenue Code	450
Min. Negotiated Rate	$36.74
Max. Negotiated Rate	$755.86
Rate for Payer: Aetna Commercial	$473.69
Rate for Payer: Aetna Medicare Advantage	$473.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.63
Rate for Payer: Cigna Commercial	$755.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.26
Rate for Payer: Qualcare PPO/HMO/WC	$236.84

I&D EYELID ABSCESS

Facility

$1,578.95

Service Code	HCPCS 67700
Hospital Charge Code	5780250
Hospital Revenue Code	450
Min. Negotiated Rate	$236.84
Max. Negotiated Rate	$236.84
Rate for Payer: Qualcare PPO/HMO/WC	$236.84

I&D HEMATOMA

Facility

$882.00

Service Code	HCPCS 10140
Hospital Charge Code	87502125
Hospital Revenue Code	761
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$132.30
Rate for Payer: Qualcare PPO/HMO/WC	$132.30

I&D HEMATOMA

Facility

$882.00

Service Code	HCPCS 10140
Hospital Charge Code	87502125
Hospital Revenue Code	761
Min. Negotiated Rate	$43.47
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$264.60
Rate for Payer: Aetna Medicare Advantage	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.91
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.66
Rate for Payer: Oxford Commercial	$441.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.30
Rate for Payer: UnitedHealthcare Commercial	$441.00

I&D HEMATOMA/FLUID

Facility

$5,638.35

Service Code	HCPCS 10140
Hospital Charge Code	16000308
Hospital Revenue Code	360
Min. Negotiated Rate	$732.99
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,691.51
Rate for Payer: Aetna Medicare Advantage	$1,691.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,437.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,437.78
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	$1,437.78
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.99
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$845.75
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

I&D HEMATOMA/FLUID

Facility

$5,638.35

Service Code	HCPCS 10140
Hospital Charge Code	16000308
Hospital Revenue Code	360
Min. Negotiated Rate	$845.75
Max. Negotiated Rate	$845.75
Rate for Payer: Qualcare PPO/HMO/WC	$845.75

I&D LEG/ANKLE DEEP ABSC/HEMATO

Facility

$10,870.60

Service Code	HCPCS 27603
Hospital Charge Code	16000889
Hospital Revenue Code	360
Min. Negotiated Rate	$1,630.59
Max. Negotiated Rate	$1,630.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59

I&D LEG/ANKLE DEEP ABSC/HEMATO

Facility

$10,870.60

Service Code	HCPCS 27603
Hospital Charge Code	16000889
Hospital Revenue Code	360
Min. Negotiated Rate	$1,413.18
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$3,261.18
Rate for Payer: Aetna Medicare Advantage	$3,261.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,772.00
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	$2,772.00
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,413.18
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

I&D OF SUBMUCOSAL ABSCESS,RCTM

Facility

$16,865.10

Service Code	HCPCS 45005
Hospital Charge Code	16000643
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,059.53
Rate for Payer: Aetna Commercial	$5,059.53
Rate for Payer: Aetna Medicare Advantage	$5,059.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,300.60
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	$4,300.60
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,192.46
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

I&D OF SUBMUCOSAL ABSCESS,RCTM

Facility

$16,865.10

Service Code	HCPCS 45005
Hospital Charge Code	16000643
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

IDOSORB GEL 40 GM

Facility

$184.95

Hospital Charge Code	60630080W
Hospital Revenue Code	250
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$27.74
Rate for Payer: Qualcare PPO/HMO/WC	$27.74

IDOSORB GEL 40 GM

Facility

$184.95

Hospital Charge Code	60630080W
Hospital Revenue Code	250
Min. Negotiated Rate	$24.04
Max. Negotiated Rate	$92.47
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.16
Rate for Payer: Cigna Commercial	$92.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.04
Rate for Payer: Oxford Commercial	$92.47
Rate for Payer: Qualcare PPO/HMO/WC	$27.74
Rate for Payer: UnitedHealthcare Commercial	$92.47

IDOXURIDINE OINT 5GM

Facility

$70.40

Hospital Charge Code	6003016
Hospital Revenue Code	252
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

IDOXURIDINE OINT 5GM

Facility

$70.40

Hospital Charge Code	6003016
Hospital Revenue Code	252
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

IDOXURIDINE SOL 15ML

Facility

$82.60

Hospital Charge Code	6003024
Hospital Revenue Code	252
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

IDOXURIDINE SOL 15ML

Facility

$82.60

Hospital Charge Code	6003024
Hospital Revenue Code	252
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.74
Rate for Payer: Oxford Commercial	$41.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$41.30

I&D PALATE OR UVULA

Facility

$1,453.00

Service Code	HCPCS 42000
Hospital Charge Code	5780200
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

Know your out-of-pocket cost for care.

All Charges