Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMPLNT TESTCLR OVL SZ 3210-047

Facility

$2,976.00

Hospital Charge Code	270612832
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-047

Facility

$2,976.00

Hospital Charge Code	270612832
Hospital Revenue Code	272
Min. Negotiated Rate	$386.88
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$892.80
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.88
Rate for Payer: Oxford Commercial	$1,488.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$1,488.00

IMPLNT TESTCLR OVL SZ 3210-050

Facility

$2,976.00

Hospital Charge Code	270612833
Hospital Revenue Code	272
Min. Negotiated Rate	$446.40
Max. Negotiated Rate	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$446.40

IMPLNT TESTCLR OVL SZ 3210-050

Facility

$2,976.00

Hospital Charge Code	270612833
Hospital Revenue Code	272
Min. Negotiated Rate	$386.88
Max. Negotiated Rate	$1,488.00
Rate for Payer: Aetna Commercial	$892.80
Rate for Payer: Aetna Medicare Advantage	$892.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.88
Rate for Payer: Cigna Commercial	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.88
Rate for Payer: Oxford Commercial	$1,488.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.40
Rate for Payer: UnitedHealthcare Commercial	$1,488.00

IMPL SUBTALAR HYPROCURE II SZ8

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$9,987.50
Rate for Payer: Aetna Commercial	$5,992.50
Rate for Payer: Aetna Medicare Advantage	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.62
Rate for Payer: Cigna Commercial	$9,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

IMPL SUBTALAR HYPROCURE II SZ8

Facility

$19,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270693926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.25
Max. Negotiated Rate	$4,833.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,833.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.25

IMPLT PORT 19X1 SAF WO Y PWRLC

Facility

$57.00

Service Code	HCPCS C1788
Hospital Charge Code	270668314
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$13.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.79
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

IMPLT PORT 19X1 SAF WO Y PWRLC

Facility

$57.00

Service Code	HCPCS C1788
Hospital Charge Code	270668314
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.79
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

IMP METATARSAL PHAL SZ 30

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668131
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$3,140.00
Rate for Payer: Aetna Commercial	$1,884.00
Rate for Payer: Aetna Medicare Advantage	$1,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.40
Rate for Payer: Cigna Commercial	$3,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

IMP METATARSAL PHAL SZ 30

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668131
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$1,519.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$2,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: Aetna Commercial	$1,462.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$633.75
Rate for Payer: Oxford Commercial	$2,437.50
Rate for Payer: UnitedHealthcare Commercial	$2,437.50

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$391.85
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$904.26
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.85
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$391.85
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$904.26
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.85
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

IMV SET-UP***

Facility

$32.40

Hospital Charge Code	9500463
Hospital Revenue Code	279
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna Commercial	$9.72
Rate for Payer: Aetna Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.21
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$16.20

IMV SET-UP***

Facility

$32.40

Hospital Charge Code	9500463
Hospital Revenue Code	279
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

IMWD 4X5 DOMESTIC

Facility

$12,155.00

Service Code	HCPCS Q4108
Hospital Charge Code	270660226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,823.25
Max. Negotiated Rate	$2,941.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,431.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,941.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,823.25

IMWD 4X5 DOMESTIC

Facility

$12,155.00

Service Code	HCPCS Q4108
Hospital Charge Code	270660226
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,646.50
Rate for Payer: Aetna Commercial	$3,646.50
Rate for Payer: Aetna Medicare Advantage	$3,646.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,099.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,099.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,099.53
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,941.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,823.25

In-111 Chloride

Facility

$2,677.25

Hospital Charge Code	4509078
Hospital Revenue Code	343
Min. Negotiated Rate	$401.59
Max. Negotiated Rate	$401.59
Rate for Payer: Qualcare PPO/HMO/WC	$401.59

In-111 Chloride

Facility

$2,677.25

Hospital Charge Code	4509078
Hospital Revenue Code	343
Min. Negotiated Rate	$348.04
Max. Negotiated Rate	$1,338.62
Rate for Payer: Aetna Commercial	$803.17
Rate for Payer: Aetna Medicare Advantage	$803.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$682.70
Rate for Payer: Cigna Commercial	$1,338.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.04
Rate for Payer: Qualcare PPO/HMO/WC	$401.59

IN 111 LABELED WBC 20.0 MCI

Facility

$258.67

Hospital Charge Code	4509094
Hospital Revenue Code	343
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$129.34
Rate for Payer: Aetna Commercial	$77.60
Rate for Payer: Aetna Medicare Advantage	$77.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.96
Rate for Payer: Cigna Commercial	$129.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

IN 111 LABELED WBC 20.0 MCI

Facility

$258.67

Hospital Charge Code	4509094
Hospital Revenue Code	343
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

IN 111 LABELED WBC PER DOSE

Facility

$7,612.71

Service Code	HCPCS A9570
Hospital Charge Code	4509081
Hospital Revenue Code	343
Min. Negotiated Rate	$1,141.91
Max. Negotiated Rate	$1,141.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.91

Know your out-of-pocket cost for care.

All Charges