Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTEGRILIN 75MG/100ML INJ

Facility

$602.00

Hospital Charge Code	60635296
Hospital Revenue Code	636
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$301.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.68
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

INTEGRL 180MM RDCD PROX 17X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270687777
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$25,194.00
Rate for Payer: Aetna Commercial	$15,116.40
Rate for Payer: Aetna Medicare Advantage	$15,116.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,848.94
Rate for Payer: Cigna Commercial	$25,194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRL 180MM RDCD PROX 17X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270687777
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$12,193.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRO DBM PLUS 5 244608

Facility

$4,125.00

Hospital Charge Code	270638273
Hospital Revenue Code	272
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,237.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$536.25
Rate for Payer: Oxford Commercial	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Commercial	$2,062.50

INTEGRO DBM PLUS 5 244608

Facility

$4,125.00

Hospital Charge Code	270638273
Hospital Revenue Code	272
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$618.75
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

INTEGR SHRT GTRW/2 CABLE 23X53

Facility

$8,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270663515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.38
Max. Negotiated Rate	$2,052.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,696.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,052.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,272.38

INTEGR SHRT GTRW/2 CABLE 23X53

Facility

$8,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270663515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.38
Max. Negotiated Rate	$4,241.25
Rate for Payer: Aetna Commercial	$2,544.75
Rate for Payer: Aetna Medicare Advantage	$2,544.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,163.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,163.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,163.04
Rate for Payer: Cigna Commercial	$4,241.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,052.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,272.38

INTELLIJOINT HIP KIT

Facility

$5,425.00

Service Code	HCPCS C1776
Hospital Charge Code	270704147
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$1,312.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

INTELLIJOINT HIP KIT

Facility

$5,425.00

Service Code	HCPCS C1776
Hospital Charge Code	270704147
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$2,712.50
Rate for Payer: Aetna Commercial	$1,627.50
Rate for Payer: Aetna Medicare Advantage	$1,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,383.38
Rate for Payer: Cigna Commercial	$2,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546747
Hospital Revenue Code	914
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546755
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546747
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546755
Hospital Revenue Code	914
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$5,170.92

Service Code	APR-DRG 8171
Min. Negotiated Rate	$5,069.53
Max. Negotiated Rate	$5,170.92
Rate for Payer: Aetna Better Health Medicaid	$5,069.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,170.92

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$11,254.70

Service Code	APR-DRG 8173
Min. Negotiated Rate	$11,034.02
Max. Negotiated Rate	$11,254.70
Rate for Payer: Aetna Better Health Medicaid	$11,034.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,254.70

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$6,607.62

Service Code	APR-DRG 8172
Min. Negotiated Rate	$6,478.06
Max. Negotiated Rate	$6,607.62
Rate for Payer: Aetna Better Health Medicaid	$6,478.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,607.62

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$22,356.32

Service Code	APR-DRG 8174
Min. Negotiated Rate	$21,917.96
Max. Negotiated Rate	$22,356.32
Rate for Payer: Aetna Better Health Medicaid	$21,917.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,356.32

INTERAC INDIV PT OP 20-30M W/O

Facility

$534.40

Service Code	HCPCS 90810
Hospital Charge Code	9310130
Hospital Revenue Code	914
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$80.16
Rate for Payer: Qualcare PPO/HMO/WC	$80.16

INTERAC INDIV PT OP 20-30M W/O

Facility

$534.40

Service Code	HCPCS 90810
Hospital Charge Code	9310130
Hospital Revenue Code	914
Min. Negotiated Rate	$69.47
Max. Negotiated Rate	$267.20
Rate for Payer: Aetna Commercial	$160.32
Rate for Payer: Aetna Medicare Advantage	$160.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.27
Rate for Payer: Cigna Commercial	$267.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.47
Rate for Payer: Qualcare PPO/HMO/WC	$80.16

INTERAC INDIV PT OP 45-50M W/O

Facility

$751.40

Service Code	HCPCS 90812
Hospital Charge Code	9310135
Hospital Revenue Code	914
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$375.70
Rate for Payer: Aetna Commercial	$225.42
Rate for Payer: Aetna Medicare Advantage	$225.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.61
Rate for Payer: Cigna Commercial	$375.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.68
Rate for Payer: Qualcare PPO/HMO/WC	$112.71

INTERAC INDIV PT OP 45-50M W/O

Facility

$751.40

Service Code	HCPCS 90812
Hospital Charge Code	9310135
Hospital Revenue Code	914
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$112.71
Rate for Payer: Qualcare PPO/HMO/WC	$112.71

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4510709
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4822709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4822709
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4515709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

Know your out-of-pocket cost for care.

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