Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	7411607
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	411050431
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

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	2600239
Hospital Revenue Code	361
Min. Negotiated Rate	$428.02
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$493.88
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	7411607
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	$428.02
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$987.75
Rate for Payer: Aetna Medicare Advantage	$987.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$839.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$839.59
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	$839.59
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.02
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$493.88
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	2600239
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

INJ NEPH/URETEROGRAM NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	7411606
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 NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	2600238
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 NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	2600238
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 NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	7411606
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEUROLYTIC,EPID CERV/THOR

Facility

$18,351.40

Service Code	HCPCS 62281
Hospital Charge Code	1600000774
Hospital Revenue Code	360
Min. Negotiated Rate	$2,752.71
Max. Negotiated Rate	$2,752.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71

INJ NEUROLYTIC,EPID CERV/THOR

Facility

$18,351.40

Service Code	HCPCS 62281
Hospital Charge Code	1600000774
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,505.42
Rate for Payer: Aetna Commercial	$5,505.42
Rate for Payer: Aetna Medicare Advantage	$5,505.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.61
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	$4,679.61
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,385.68
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ NON-COMP FOAM SCLEROSANT M

Facility

$6,273.72

Service Code	HCPCS 36466
Hospital Charge Code	404636466
Hospital Revenue Code	361
Min. Negotiated Rate	$815.58
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$1,882.12
Rate for Payer: Aetna Medicare Advantage	$1,882.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,599.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,599.80
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	$1,599.80
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.58
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$941.06
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

INJ NON-COMP FOAM SCLEROSANT M

Facility

$6,273.72

Service Code	HCPCS 36466
Hospital Charge Code	404636466
Hospital Revenue Code	361
Min. Negotiated Rate	$941.06
Max. Negotiated Rate	$941.06
Rate for Payer: Qualcare PPO/HMO/WC	$941.06

INJ NON COMP FOAM SCLEROSANT S

Facility

$6,273.72

Service Code	HCPCS 36465
Hospital Charge Code	1600000782
Hospital Revenue Code	360
Min. Negotiated Rate	$941.06
Max. Negotiated Rate	$941.06
Rate for Payer: Qualcare PPO/HMO/WC	$941.06

INJ NON COMP FOAM SCLEROSANT S

Facility

$6,273.72

Service Code	HCPCS 36465
Hospital Charge Code	1600000782
Hospital Revenue Code	360
Min. Negotiated Rate	$815.58
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$1,882.12
Rate for Payer: Aetna Medicare Advantage	$1,882.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,599.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,599.80
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	$1,599.80
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.58
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$941.06
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

INJ NON-COMP FOAM SCLEROSANT S

Facility

$6,273.72

Service Code	HCPCS 36465
Hospital Charge Code	404636465
Hospital Revenue Code	361
Min. Negotiated Rate	$941.06
Max. Negotiated Rate	$941.06
Rate for Payer: Qualcare PPO/HMO/WC	$941.06

INJ NON-COMP FOAM SCLEROSANT S

Facility

$6,273.72

Service Code	HCPCS 36465
Hospital Charge Code	404636465
Hospital Revenue Code	361
Min. Negotiated Rate	$815.58
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$1,882.12
Rate for Payer: Aetna Medicare Advantage	$1,882.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,599.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,599.80
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	$1,599.80
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.58
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$941.06
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

INJ ONABOTULINUMTOXIN BOXTOX

Facility

$3,876.00

Hospital Charge Code	606390578
Hospital Revenue Code	252
Min. Negotiated Rate	$503.88
Max. Negotiated Rate	$1,938.00
Rate for Payer: Aetna Commercial	$1,162.80
Rate for Payer: Aetna Medicare Advantage	$1,162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.38
Rate for Payer: Cigna Commercial	$1,938.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.88
Rate for Payer: Oxford Commercial	$1,938.00
Rate for Payer: Qualcare PPO/HMO/WC	$581.40
Rate for Payer: UnitedHealthcare Commercial	$1,938.00

INJ ONABOTULINUMTOXIN BOXTOX

Facility

$3,876.00

Hospital Charge Code	606390578
Hospital Revenue Code	252
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$581.40
Rate for Payer: Qualcare PPO/HMO/WC	$581.40

INJ PARAVERT F JNT C/T 1 LEV

Facility

$5,111.97

Service Code	HCPCS 64490
Hospital Charge Code	321564490
Hospital Revenue Code	361
Min. Negotiated Rate	$664.56
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$1,533.59
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT C/T 1 LEV

Facility

$5,111.97

Service Code	HCPCS 64490
Hospital Charge Code	321564490
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

INJ PARAVERT F JNT C/T 2 LEV

Facility

$7,956.80

Service Code	HCPCS 64491
Hospital Charge Code	16000654
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ PARAVERT F JNT C/T 2 LEV

Facility

$7,956.80

Service Code	HCPCS 64491
Hospital Charge Code	411064491
Hospital Revenue Code	361
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$2,387.04
Rate for Payer: Aetna Commercial	$2,387.04
Rate for Payer: Aetna Medicare Advantage	$2,387.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,028.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,028.98
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	$2,028.98
Rate for Payer: Cigna Commercial	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT C/T 2 LEV

Facility

$5,111.97

Service Code	HCPCS 64491
Hospital Charge Code	321564491
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

Know your out-of-pocket cost for care.

All Charges