Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJ.SCLEROSING SOL.SINGLE VEIN

Facility

$623.14

Service Code	HCPCS 36470
Hospital Charge Code	75190140
Hospital Revenue Code	510
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

INJ.SCLEROSONG SOL.MULT.VEINS

Facility

$623.14

Service Code	HCPCS 36471
Hospital Charge Code	75190145
Hospital Revenue Code	510
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$186.94
Rate for Payer: Aetna Medicare Advantage	$186.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

INJ.SCLEROSONG SOL.MULT.VEINS

Facility

$623.14

Service Code	HCPCS 36471
Hospital Charge Code	75190145
Hospital Revenue Code	510
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

INJ SGL TENDON SHTH/LIGAMENT

Facility

$2,521.79

Service Code	HCPCS 20550
Hospital Charge Code	1600000316
Hospital Revenue Code	360
Min. Negotiated Rate	$327.83
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$756.54
Rate for Payer: Aetna Medicare Advantage	$756.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$643.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$643.06
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	$643.06
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.83
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.27
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ SGL TENDON SHTH/LIGAMENT

Facility

$2,521.79

Service Code	HCPCS 20550
Hospital Charge Code	1600000316
Hospital Revenue Code	360
Min. Negotiated Rate	$378.27
Max. Negotiated Rate	$378.27
Rate for Payer: Qualcare PPO/HMO/WC	$378.27

INJ SPINE DISK X-R CERV/THOR

Facility

$8,254.60

Service Code	HCPCS 62291
Hospital Charge Code	1600000424
Hospital Revenue Code	360
Min. Negotiated Rate	$145.04
Max. Negotiated Rate	$2,476.38
Rate for Payer: Aetna Commercial	$2,476.38
Rate for Payer: Aetna Medicare Advantage	$2,476.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,104.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,104.92
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	$2,104.92
Rate for Payer: Cigna Commercial	$145.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,238.19
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ SPINE DISK X-R CERV/THOR

Facility

$8,254.60

Service Code	HCPCS 62291
Hospital Charge Code	1600000424
Hospital Revenue Code	360
Min. Negotiated Rate	$1,238.19
Max. Negotiated Rate	$1,238.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,238.19

INJ TENDON, LIGAMENT, GANGLION

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	84506001
Hospital Revenue Code	361
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$327.30
Rate for Payer: Aetna Medicare Advantage	$327.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.20
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	$278.20
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.83
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ TENDON, LIGAMENT, GANGLION

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	84506001
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

INJ TENDON OGIN/INSERT

Facility

$2,401.70

Service Code	HCPCS 20551
Hospital Charge Code	16000539
Hospital Revenue Code	360
Min. Negotiated Rate	$312.22
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$720.51
Rate for Payer: Aetna Medicare Advantage	$720.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.43
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	$612.43
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.22
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ TENDON OGIN/INSERT

Facility

$2,401.70

Service Code	HCPCS 20551
Hospital Charge Code	16000539
Hospital Revenue Code	360
Min. Negotiated Rate	$360.25
Max. Negotiated Rate	$360.25
Rate for Payer: Qualcare PPO/HMO/WC	$360.25

INJ TENDON ORIGIN/INSERTION

Facility

$1,630.99

Service Code	HCPCS 20551
Hospital Charge Code	321520551
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

INJ TENDON ORIGIN/INSERTION

Facility

$1,630.99

Service Code	HCPCS 20551
Hospital Charge Code	321520551
Hospital Revenue Code	361
Min. Negotiated Rate	$212.03
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$489.30
Rate for Payer: Aetna Medicare Advantage	$489.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.90
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	$415.90
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.03
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ TENDON SHEATH/LIGAMENT

Facility

$1,630.99

Service Code	HCPCS 20550
Hospital Charge Code	321520550
Hospital Revenue Code	361
Min. Negotiated Rate	$212.03
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$489.30
Rate for Payer: Aetna Medicare Advantage	$489.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.90
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	$415.90
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.03
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ TENDON SHEATH/LIGAMENT

Facility

$1,630.99

Service Code	HCPCS 20550
Hospital Charge Code	321520550
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

INJ THIETHYLPRAZINE 5MG/ML 2M

Facility

$34.60

Hospital Charge Code	6005300
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

INJ THIETHYLPRAZINE 5MG/ML 2M

Facility

$34.60

Hospital Charge Code	6005300
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

INJ TRIGGER POINT 1/2 MUSCL

Facility

$1,147.71

Service Code	HCPCS 20552
Hospital Charge Code	1600000599
Hospital Revenue Code	360
Min. Negotiated Rate	$149.20
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$344.31
Rate for Payer: Aetna Medicare Advantage	$344.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.67
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	$292.67
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.16
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ TRIGGER POINT 1/2 MUSCL

Facility

$1,147.71

Service Code	HCPCS 20552
Hospital Charge Code	1600000599
Hospital Revenue Code	360
Min. Negotiated Rate	$172.16
Max. Negotiated Rate	$172.16
Rate for Payer: Qualcare PPO/HMO/WC	$172.16

INJ-TRIGGER POINT, 1/2 MUSCLE

Facility

$1,091.00

Service Code	HCPCS 20552
Hospital Charge Code	75190120
Hospital Revenue Code	361
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$327.30
Rate for Payer: Aetna Medicare Advantage	$327.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.20
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	$278.20
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.83
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ-TRIGGER POINT, 1/2 MUSCLE

Facility

$1,091.00

Service Code	HCPCS 20552
Hospital Charge Code	75190120
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

INK CARTRIDGE

Facility

$214.75

Hospital Charge Code	270656361
Hospital Revenue Code	271
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$32.21
Rate for Payer: Qualcare PPO/HMO/WC	$32.21

INK CARTRIDGE

Facility

$214.75

Hospital Charge Code	270656361
Hospital Revenue Code	271
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$107.38
Rate for Payer: Aetna Commercial	$64.42
Rate for Payer: Aetna Medicare Advantage	$64.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.76
Rate for Payer: Cigna Commercial	$107.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.92
Rate for Payer: Oxford Commercial	$107.38
Rate for Payer: Qualcare PPO/HMO/WC	$32.21
Rate for Payer: UnitedHealthcare Commercial	$107.38

INK INDIA VL 10ML 500200IN

Facility

$158.45

Hospital Charge Code	270622581
Hospital Revenue Code	270
Min. Negotiated Rate	$20.60
Max. Negotiated Rate	$79.22
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna Medicare Advantage	$47.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.40
Rate for Payer: Cigna Commercial	$79.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.60
Rate for Payer: Oxford Commercial	$79.22
Rate for Payer: Qualcare PPO/HMO/WC	$23.77
Rate for Payer: UnitedHealthcare Commercial	$79.22

INK INDIA VL 10ML 500200IN

Facility

$158.45

Hospital Charge Code	270622581
Hospital Revenue Code	270
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$23.77
Rate for Payer: Qualcare PPO/HMO/WC	$23.77

Know your out-of-pocket cost for care.

All Charges