Heights University Hospital

All Charges

Charge

Type

Setting

Price

I&D PALATE OR UVULA

Facility

$1,453.00

Service Code	HCPCS 42000
Hospital Charge Code	5780200
Hospital Revenue Code	450
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$564.04
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: Aetna Medicare Advantage	$435.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.51
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.89
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

I&D PELV/HIP JNT ABSC,DEEP

Facility

$19,467.90

Service Code	HCPCS 26990
Hospital Charge Code	1600000485
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

I&D PELV/HIP JNT ABSC,DEEP

Facility

$19,467.90

Service Code	HCPCS 26990
Hospital Charge Code	1600000485
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$5,840.37
Rate for Payer: Aetna Medicare Advantage	$5,840.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,964.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,964.31
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	$4,964.31
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,530.83
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

I&D,PERECTAL OR ISCHIAL ABSCES

Facility

$16,865.10

Service Code	HCPCS 46040
Hospital Charge Code	1600000564
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

I&D,PERECTAL OR ISCHIAL ABSCES

Facility

$16,865.10

Service Code	HCPCS 46040
Hospital Charge Code	1600000564
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;PERIRECTAL/ISCHIAL ABSCESS

Facility

$17,708.36

Service Code	HCPCS 46040
Hospital Charge Code	1600000295
Hospital Revenue Code	360
Min. Negotiated Rate	$2,656.25
Max. Negotiated Rate	$2,656.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,656.25

I&D;PERIRECTAL/ISCHIAL ABSCESS

Facility

$17,708.36

Service Code	HCPCS 46040
Hospital Charge Code	1600000295
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,312.51
Rate for Payer: Aetna Commercial	$5,312.51
Rate for Payer: Aetna Medicare Advantage	$5,312.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,515.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,515.63
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	$4,515.63
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,302.09
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,656.25
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

I & D PILONIDAL CYST SIMPLE

Facility

$4,142.95

Service Code	HCPCS 10080
Hospital Charge Code	1600000287
Hospital Revenue Code	360
Min. Negotiated Rate	$621.44
Max. Negotiated Rate	$621.44
Rate for Payer: Qualcare PPO/HMO/WC	$621.44

I & D PILONIDAL CYST SIMPLE

Facility

$4,142.95

Service Code	HCPCS 10080
Hospital Charge Code	1600000287
Hospital Revenue Code	360
Min. Negotiated Rate	$538.58
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,242.88
Rate for Payer: Aetna Medicare Advantage	$1,242.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,056.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,056.45
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	$1,056.45
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.58
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$621.44
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

I&D VULVA/PERINEUM ABSCESS

Facility

$1,573.30

Service Code	HCPCS 56405
Hospital Charge Code	412356405
Hospital Revenue Code	361
Min. Negotiated Rate	$236.00
Max. Negotiated Rate	$236.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.00

I&D VULVA/PERINEUM ABSCESS

Facility

$1,573.30

Service Code	HCPCS 56405
Hospital Charge Code	412356405
Hospital Revenue Code	361
Min. Negotiated Rate	$204.53
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$471.99
Rate for Payer: Aetna Medicare Advantage	$471.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.19
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	$401.19
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.53
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

I- FACTOR 1CC

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270692259
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

I- FACTOR 1CC

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270692259
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IFEX/3GM/VIAL

Facility

$593.00

Hospital Charge Code	60634828
Hospital Revenue Code	636
Min. Negotiated Rate	$88.95
Max. Negotiated Rate	$296.50
Rate for Payer: Aetna Commercial	$177.90
Rate for Payer: Aetna Medicare Advantage	$177.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.22
Rate for Payer: Cigna Commercial	$296.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.51
Rate for Payer: Qualcare PPO/HMO/WC	$88.95

IFEX/3GM/VIAL

Facility

$593.00

Hospital Charge Code	60634828
Hospital Revenue Code	636
Min. Negotiated Rate	$88.95
Max. Negotiated Rate	$143.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.51
Rate for Payer: Qualcare PPO/HMO/WC	$88.95

IFEX/MESNEX COMBO 1GM/200

Facility

$184.00

Hospital Charge Code	60633149
Hospital Revenue Code	636
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$44.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

IFEX/MESNEX COMBO 1GM/200

Facility

$184.00

Hospital Charge Code	60633149
Hospital Revenue Code	636
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$55.20
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

IFOSFAMIDE INJ 1GM

Facility

$277.15

Hospital Charge Code	6000350
Hospital Revenue Code	636
Min. Negotiated Rate	$41.57
Max. Negotiated Rate	$67.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.07
Rate for Payer: Qualcare PPO/HMO/WC	$41.57

IFOSFAMIDE INJ 1GM

Facility

$277.15

Hospital Charge Code	6000350
Hospital Revenue Code	636
Min. Negotiated Rate	$41.57
Max. Negotiated Rate	$138.57
Rate for Payer: Aetna Commercial	$83.14
Rate for Payer: Aetna Medicare Advantage	$83.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.67
Rate for Payer: Cigna Commercial	$138.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.07
Rate for Payer: Qualcare PPO/HMO/WC	$41.57

IFUSE-3D IMPLANT 7.0MM X 50MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692837
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$5,229.00
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE-3D IMPLANT 7.0MM X 50MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692837
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE-3D IMPLANT 7.0MM X 65MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692836
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE-3D IMPLANT 7.0MM X 65MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692836
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$5,229.00
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE IMPLANT SYST 7.0X30MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270694944
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$5,229.00
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE IMPLANT SYST 7.0X30MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270694944
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

Know your out-of-pocket cost for care.

All Charges