Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$771.49
Max. Negotiated Rate	$2,283.81
Rate for Payer: Aetna Commercial	$2,283.81
Rate for Payer: Aetna Medicare Advantage	$2,283.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,941.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,941.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$771.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,941.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.91

IN 111 PENTETATE PER 0.5 MCI

Facility

$6,984.14

Hospital Charge Code	4509079
Hospital Revenue Code	343
Min. Negotiated Rate	$1,047.62
Max. Negotiated Rate	$1,047.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.62

IN 111 PENTETATE PER 0.5 MCI

Facility

$6,984.14

Hospital Charge Code	4509079
Hospital Revenue Code	343
Min. Negotiated Rate	$907.94
Max. Negotiated Rate	$3,492.07
Rate for Payer: Aetna Commercial	$2,095.24
Rate for Payer: Aetna Medicare Advantage	$2,095.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,780.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,780.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,780.96
Rate for Payer: Cigna Commercial	$3,492.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.62

IN-111 PENTETREOTIDE PER DOSE

Facility

$12,338.65

Service Code	HCPCS A9572
Hospital Charge Code	4509080
Hospital Revenue Code	343
Min. Negotiated Rate	$1,850.80
Max. Negotiated Rate	$1,850.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,850.80

IN-111 PENTETREOTIDE PER DOSE

Facility

$12,338.65

Service Code	HCPCS A9572
Hospital Charge Code	4509080
Hospital Revenue Code	343
Min. Negotiated Rate	$1,432.12
Max. Negotiated Rate	$3,701.59
Rate for Payer: Aetna Commercial	$3,701.59
Rate for Payer: Aetna Medicare Advantage	$3,701.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,146.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,146.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,146.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,604.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,850.80

INBONE SCREW REMOVAL

Facility

$680.00

Hospital Charge Code	270687135
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

INBONE SCREW REMOVAL

Facility

$680.00

Hospital Charge Code	270687135
Hospital Revenue Code	272
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$204.00
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.40
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$340.00

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$53,099.73

Service Code	MSDRG 642
Min. Negotiated Rate	$15,518.78
Max. Negotiated Rate	$53,099.73
Rate for Payer: Aetna Commercial	$47,953.03
Rate for Payer: Aetna Medicare Advantage	$15,518.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,699.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,837.10
Rate for Payer: Cigna Commercial	$30,605.01
Rate for Payer: Cigna Medicare Advantage	$17,699.91
Rate for Payer: Clover Medicare Advantage	$16,814.91
Rate for Payer: EmblemHealth Commercial	$53,099.73
Rate for Payer: Humana Medicare Advantage	$18,230.91
Rate for Payer: Oxford Commercial	$19,127.24
Rate for Payer: UnitedHealthcare Commercial	$21,711.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,699.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18,761.90
Rate for Payer: Wellcare Medicare Advantage	$17,699.91

INBORN ERRORS OF METABOLISM

Facility

$7,257.84

Service Code	APR-DRG 4231
Min. Negotiated Rate	$5,804.26
Max. Negotiated Rate	$7,257.84
Rate for Payer: Aetna Better Health Medicaid	$7,115.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,257.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5,804.26

INBORN ERRORS OF METABOLISM

Facility

$14,772.72

Service Code	APR-DRG 4233
Min. Negotiated Rate	$11,939.99
Max. Negotiated Rate	$14,772.72
Rate for Payer: Aetna Better Health Medicaid	$14,483.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,772.72
Rate for Payer: Wellpoint Medicaid Managed Care	$11,939.99

INBORN ERRORS OF METABOLISM

Facility

$34,449.49

Service Code	APR-DRG 4234
Min. Negotiated Rate	$23,135.42
Max. Negotiated Rate	$34,449.49
Rate for Payer: Aetna Better Health Medicaid	$33,774.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,449.49
Rate for Payer: Wellpoint Medicaid Managed Care	$23,135.42

INBORN ERRORS OF METABOLISM

Facility

$9,226.75

Service Code	APR-DRG 4232
Min. Negotiated Rate	$7,565.78
Max. Negotiated Rate	$9,226.75
Rate for Payer: Aetna Better Health Medicaid	$9,045.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,226.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7,565.78

INC ACHILLES TENDON W GN ANSTH

Facility

$19,467.90

Service Code	HCPCS 27606
Hospital Charge Code	16000479
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

INC ACHILLES TENDON W GN ANSTH

Facility

$19,467.90

Service Code	HCPCS 27606
Hospital Charge Code	16000479
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

INCENTIVE PROCEDURE SUPPLY****

Facility

$21.00

Hospital Charge Code	9500133
Hospital Revenue Code	279
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

INCENTIVE PROCEDURE SUPPLY****

Facility

$21.00

Hospital Charge Code	9500133
Hospital Revenue Code	279
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

INCENTIVE SPIROMETER 4000 ML

Facility

$9.95

Hospital Charge Code	270651469
Hospital Revenue Code	270
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

INCENTIVE SPIROMETER 4000 ML

Facility

$9.95

Hospital Charge Code	270651469
Hospital Revenue Code	270
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$4.97
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare Advantage	$2.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.29
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$4.97

INCENTIVE SPIROMETER W/DEV****

Facility

$98.90

Hospital Charge Code	9500134
Hospital Revenue Code	419
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$29.67
Rate for Payer: Aetna Medicare Advantage	$29.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.22
Rate for Payer: Cigna Commercial	$49.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.86
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.84
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

INCENTIVE SPIROMETER W/DEV****

Facility

$98.90

Hospital Charge Code	9500134
Hospital Revenue Code	419
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$14.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.84

INCIS 1 VERTEBRAL SEG LUMBAR

Facility

$6,759.00

Service Code	HCPCS 22214
Hospital Charge Code	1600000764
Hospital Revenue Code	360
Min. Negotiated Rate	$878.67
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$2,027.70
Rate for Payer: Aetna Medicare Advantage	$2,027.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.55
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	$1,723.55
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.85
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

INCIS 1 VERTEBRAL SEG LUMBAR

Facility

$6,759.00

Service Code	HCPCS 22214
Hospital Charge Code	1600000764
Hospital Revenue Code	360
Min. Negotiated Rate	$1,013.85
Max. Negotiated Rate	$1,013.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.85

INCISE FOOT/TOE FASCIA

Facility

$26,594.63

Service Code	HCPCS 28008
Hospital Charge Code	16000235
Hospital Revenue Code	360
Min. Negotiated Rate	$3,989.19
Max. Negotiated Rate	$3,989.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,989.19

INCISE FOOT/TOE FASCIA

Facility

$26,594.63

Service Code	HCPCS 28008
Hospital Charge Code	16000235
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,978.39
Rate for Payer: Aetna Commercial	$7,978.39
Rate for Payer: Aetna Medicare Advantage	$7,978.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,781.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,781.63
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	$6,781.63
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,457.30
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,989.19
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

INCISE HAND/FINGER TENDON

Facility

$7,538.96

Service Code	HCPCS 26460
Hospital Charge Code	1600000395
Hospital Revenue Code	360
Min. Negotiated Rate	$980.06
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$2,261.69
Rate for Payer: Aetna Medicare Advantage	$2,261.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,922.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,922.43
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	$1,922.43
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.06
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.84
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

Know your out-of-pocket cost for care.

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