Heights University Hospital

All Charges

Charge

Type

Setting

Price

IO EXPAND INTERB SYS 10X22MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698134
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$31,250.00
Rate for Payer: Aetna Commercial	$18,750.00
Rate for Payer: Aetna Medicare Advantage	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,937.50
Rate for Payer: Cigna Commercial	$31,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

IO EXPAND INTERB SYS 10X26MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698135
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$15,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

IO EXPAND INTERB SYS 10X26MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698135
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$31,250.00
Rate for Payer: Aetna Commercial	$18,750.00
Rate for Payer: Aetna Medicare Advantage	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,937.50
Rate for Payer: Cigna Commercial	$31,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

IOHEXOL

Facility

$357.15

Hospital Charge Code	6012678
Hospital Revenue Code	250
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$53.57
Rate for Payer: Qualcare PPO/HMO/WC	$53.57

IOHEXOL

Facility

$357.15

Hospital Charge Code	6012678
Hospital Revenue Code	250
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$178.57
Rate for Payer: Aetna Commercial	$107.14
Rate for Payer: Aetna Medicare Advantage	$107.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.07
Rate for Payer: Cigna Commercial	$178.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.43
Rate for Payer: Oxford Commercial	$178.57
Rate for Payer: Qualcare PPO/HMO/WC	$53.57
Rate for Payer: UnitedHealthcare Commercial	$178.57

IOHEXOL 240 MG SOL

Facility

$350.08

Service Code	NDC 407141230
Hospital Charge Code	60627878
Hospital Revenue Code	255
Min. Negotiated Rate	$52.51
Max. Negotiated Rate	$52.51
Rate for Payer: Qualcare PPO/HMO/WC	$52.51

IOHEXOL 240 MG SOL

Facility

$350.08

Service Code	NDC 407141230
Hospital Charge Code	60627878
Hospital Revenue Code	255
Min. Negotiated Rate	$45.51
Max. Negotiated Rate	$175.04
Rate for Payer: Aetna Commercial	$105.02
Rate for Payer: Aetna Medicare Advantage	$105.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.27
Rate for Payer: Cigna Commercial	$175.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.51
Rate for Payer: Oxford Commercial	$175.04
Rate for Payer: Qualcare PPO/HMO/WC	$52.51
Rate for Payer: UnitedHealthcare Commercial	$175.04

IOHEXOL 300 100 ML

Facility

$751.00

Service Code	NDC 407141363
Hospital Charge Code	6063943209
Hospital Revenue Code	255
Min. Negotiated Rate	$97.63
Max. Negotiated Rate	$375.50
Rate for Payer: Aetna Commercial	$225.30
Rate for Payer: Aetna Medicare Advantage	$225.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.50
Rate for Payer: Cigna Commercial	$375.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.63
Rate for Payer: Oxford Commercial	$375.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.65
Rate for Payer: UnitedHealthcare Commercial	$375.50

IOHEXOL 300 100 ML

Facility

$751.00

Service Code	NDC 407141363
Hospital Charge Code	6063943209
Hospital Revenue Code	255
Min. Negotiated Rate	$112.65
Max. Negotiated Rate	$112.65
Rate for Payer: Qualcare PPO/HMO/WC	$112.65

IOHEXOL 300 50 ML

Facility

$383.31

Service Code	NDC 407141361
Hospital Charge Code	6063943211
Hospital Revenue Code	255
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.50

IOHEXOL 300 50 ML

Facility

$383.31

Service Code	NDC 407141361
Hospital Charge Code	6063943211
Hospital Revenue Code	255
Min. Negotiated Rate	$49.83
Max. Negotiated Rate	$191.66
Rate for Payer: Aetna Commercial	$114.99
Rate for Payer: Aetna Medicare Advantage	$114.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.74
Rate for Payer: Cigna Commercial	$191.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.83
Rate for Payer: Oxford Commercial	$191.66
Rate for Payer: Qualcare PPO/HMO/WC	$57.50
Rate for Payer: UnitedHealthcare Commercial	$191.66

IOHEXOL 300ML/30ML

Facility

$229.94

Service Code	NDC 407141361
Hospital Charge Code	606390584
Hospital Revenue Code	250
Min. Negotiated Rate	$29.89
Max. Negotiated Rate	$114.97
Rate for Payer: Aetna Commercial	$68.98
Rate for Payer: Aetna Medicare Advantage	$68.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.63
Rate for Payer: Cigna Commercial	$114.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.89
Rate for Payer: Oxford Commercial	$114.97
Rate for Payer: Qualcare PPO/HMO/WC	$34.49
Rate for Payer: UnitedHealthcare Commercial	$114.97

IOHEXOL 300ML/30ML

Facility

$229.94

Service Code	NDC 407141361
Hospital Charge Code	606390584
Hospital Revenue Code	250
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$34.49
Rate for Payer: Qualcare PPO/HMO/WC	$34.49

IOHEXOL(OMNI)350/ML100ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630201
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.12
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML100ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630201
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML150ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630202
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML150ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630202
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.12
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML 50ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML 50ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.12
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$251.06
Max. Negotiated Rate	$405.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: Qualcare PPO/HMO/WC	$251.06

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$502.11
Rate for Payer: Aetna Commercial	$502.11
Rate for Payer: Aetna Medicare Advantage	$502.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.79
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: Qualcare PPO/HMO/WC	$251.06

Know your out-of-pocket cost for care.

All Charges