Heights University Hospital

All Charges

Charge

Type

Setting

Price

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$732.99
Max. Negotiated Rate	$4,474.27
Rate for Payer: Aetna Better Health Medicaid	$4,386.54
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27
Rate for Payer: Wellpoint Medicaid Managed Care	$4,386.54

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$845.75
Max. Negotiated Rate	$845.75
Rate for Payer: Qualcare PPO/HMO/WC	$845.75

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$193.12
Rate for Payer: Qualcare PPO/HMO/WC	$193.12

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$167.37
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$386.24
Rate for Payer: Aetna Medicare Advantage	$386.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.30
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	$328.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.37
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.12
Rate for Payer: UnitedHealthcare Commercial	$1,686.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

INC & REM FB SQ TISSUE SIMPLE

Facility

$403.25

Service Code	HCPCS 10120
Hospital Charge Code	2500362
Hospital Revenue Code	761
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$60.49
Rate for Payer: Qualcare PPO/HMO/WC	$60.49

INC & REM FB SQ TISSUE SIMPLE

Facility

$403.25

Service Code	HCPCS 10120
Hospital Charge Code	2500362
Hospital Revenue Code	761
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$120.97
Rate for Payer: Aetna Medicare Advantage	$120.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.83
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$201.62
Rate for Payer: Qualcare PPO/HMO/WC	$60.49
Rate for Payer: UnitedHealthcare Commercial	$201.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

INCUBATION SERUM & DRUGS EACH

Facility

$150.00

Service Code	HCPCS 86975
Hospital Charge Code	3100181
Hospital Revenue Code	300
Min. Negotiated Rate	$17.77
Max. Negotiated Rate	$1,063.82
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

INCUBATION SERUM & DRUGS EACH

Facility

$150.00

Service Code	HCPCS 86975
Hospital Charge Code	3100181
Hospital Revenue Code	300
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$405.73
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

INCUBATION W INHIBITORS EACH

Facility

$200.00

Service Code	HCPCS 86977
Hospital Charge Code	3100184
Hospital Revenue Code	300
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

INCUBATION W INHIBITORS EACH

Facility

$200.00

Service Code	HCPCS 86977
Hospital Charge Code	3100184
Hospital Revenue Code	300
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$405.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.33
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$114.00

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$187.20
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$151.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

INDAPAMIDE 2.5 MG TAB

Facility

$5.56

Service Code	NDC 228257111
Hospital Charge Code	60627970
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$1.67
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.72
Rate for Payer: Oxford Commercial	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$2.78

INDAPAMIDE 2.5 MG TAB

Facility

$5.56

Service Code	NDC 228257111
Hospital Charge Code	60627970
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

INDERAL 10MG

Facility

$37.80

Hospital Charge Code	6008148
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

INDERAL 10MG

Facility

$37.80

Hospital Charge Code	6008148
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

INDERAL/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633170
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

INDERAL/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633170
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INDERAL/10MG/UD

Facility

$3.00

Hospital Charge Code	60634668
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges