Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$449.24
Max. Negotiated Rate	$449.24
Rate for Payer: Qualcare PPO/HMO/WC	$449.24

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$202.50

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

INJ GENTAMICIN IM 80MG/2ML

Facility

$5.80

Hospital Charge Code	60627237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

INJ GENTAMICIN IM 80MG/2ML

Facility

$5.80

Hospital Charge Code	60627237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

INJGRANISETRN HYDROCHLO 100MCG

Facility

$3,098.25

Hospital Charge Code	60629359
Hospital Revenue Code	636
Min. Negotiated Rate	$464.74
Max. Negotiated Rate	$749.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.78
Rate for Payer: Qualcare PPO/HMO/WC	$464.74

INJGRANISETRN HYDROCHLO 100MCG

Facility

$3,098.25

Hospital Charge Code	60629359
Hospital Revenue Code	636
Min. Negotiated Rate	$464.74
Max. Negotiated Rate	$1,549.12
Rate for Payer: Aetna Commercial	$929.48
Rate for Payer: Aetna Medicare Advantage	$929.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$790.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$790.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$790.05
Rate for Payer: Cigna Commercial	$1,549.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.78
Rate for Payer: Qualcare PPO/HMO/WC	$464.74

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$75.57
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$345.73
Rate for Payer: Aetna Medicare Advantage	$345.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.87
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	$293.87
Rate for Payer: Cigna Commercial	$75.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.82
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.87
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$172.87
Max. Negotiated Rate	$172.87
Rate for Payer: Qualcare PPO/HMO/WC	$172.87

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$149.18
Rate for Payer: Qualcare PPO/HMO/WC	$149.18

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$129.28
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$298.35
Rate for Payer: Aetna Medicare Advantage	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.60
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	$253.60
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.28
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.18
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ METARMINL BITARTRTE1% 10ML

Facility

$159.00

Hospital Charge Code	6003552
Hospital Revenue Code	636
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

INJ METARMINL BITARTRTE1% 10ML

Facility

$159.00

Hospital Charge Code	6003552
Hospital Revenue Code	636
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$38.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

INJ METOCLOPRAMIDE 50MG/10MG

Facility

$64.00

Hospital Charge Code	6007074
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

INJ METOCLOPRAMIDE 50MG/10MG

Facility

$64.00

Hospital Charge Code	6007074
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

INJ METOCLOPRAMIDE 5MG/ML

Facility

$21.15

Hospital Charge Code	6003677
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

INJ METOCLOPRAMIDE 5MG/ML

Facility

$21.15

Hospital Charge Code	6003677
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

INJ MORPHNE SLFTE 15MG/ML 20ML

Facility

$4.50

Hospital Charge Code	6003818
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$2.25

INJ MORPHNE SLFTE 15MG/ML 20ML

Facility

$4.50

Hospital Charge Code	6003818
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

INJ MYELOGRAPHY (EPIDUROGRAM)

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	84506020
Hospital Revenue Code	361
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

INJ MYELOGRAPHY (EPIDUROGRAM)

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	84506020
Hospital Revenue Code	361
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$149.40
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
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	$126.99
Rate for Payer: Cigna Commercial	$77.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.74
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	366850431
Hospital Revenue Code	361
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$927.05
Rate for Payer: Aetna Medicare Advantage	$927.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$788.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$788.00
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	$788.00
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.72
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	366850431
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	411050431
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	321050431
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

Know your out-of-pocket cost for care.

All Charges