Heights University Hospital

All Charges

Charge

Type

Setting

Price

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$686.00

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$30.29
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$69.90
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.29
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$686.00

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$69.90
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$21.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.29
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$686.00

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$16.52

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$33.05
Rate for Payer: Aetna Medicare Advantage	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.09
Rate for Payer: Cigna Commercial	$55.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.32
Rate for Payer: Oxford Commercial	$55.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.52
Rate for Payer: UnitedHealthcare Commercial	$55.08

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$98.64
Rate for Payer: Qualcare PPO/HMO/WC	$98.64

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$85.49
Max. Negotiated Rate	$328.81
Rate for Payer: Aetna Commercial	$197.28
Rate for Payer: Aetna Medicare Advantage	$197.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.69
Rate for Payer: Cigna Commercial	$328.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.49
Rate for Payer: Oxford Commercial	$328.81
Rate for Payer: Qualcare PPO/HMO/WC	$98.64
Rate for Payer: UnitedHealthcare Commercial	$328.81

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$112.91
Rate for Payer: Qualcare PPO/HMO/WC	$112.91

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$97.86
Max. Negotiated Rate	$376.38
Rate for Payer: Aetna Commercial	$225.82
Rate for Payer: Aetna Medicare Advantage	$225.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.95
Rate for Payer: Cigna Commercial	$376.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.86
Rate for Payer: Oxford Commercial	$376.38
Rate for Payer: Qualcare PPO/HMO/WC	$112.91
Rate for Payer: UnitedHealthcare Commercial	$376.38

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$164.57
Max. Negotiated Rate	$164.57
Rate for Payer: Qualcare PPO/HMO/WC	$164.57

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$548.57
Rate for Payer: Aetna Commercial	$329.14
Rate for Payer: Aetna Medicare Advantage	$329.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.77
Rate for Payer: Cigna Commercial	$548.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.63
Rate for Payer: Oxford Commercial	$548.57
Rate for Payer: Qualcare PPO/HMO/WC	$164.57
Rate for Payer: UnitedHealthcare Commercial	$548.57

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$73.17
Rate for Payer: Aetna Commercial	$43.90
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.31
Rate for Payer: Cigna Commercial	$73.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.02
Rate for Payer: Oxford Commercial	$73.17
Rate for Payer: Qualcare PPO/HMO/WC	$21.95
Rate for Payer: UnitedHealthcare Commercial	$73.17

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$21.95

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$19.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.25

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$64.16
Rate for Payer: Aetna Commercial	$38.49
Rate for Payer: Aetna Medicare Advantage	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.72
Rate for Payer: Cigna Commercial	$64.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.68
Rate for Payer: Oxford Commercial	$64.16
Rate for Payer: Qualcare PPO/HMO/WC	$19.25
Rate for Payer: UnitedHealthcare Commercial	$64.16

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$57.78
Max. Negotiated Rate	$57.78
Rate for Payer: Qualcare PPO/HMO/WC	$57.78

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$50.07
Max. Negotiated Rate	$192.59
Rate for Payer: Aetna Commercial	$115.55
Rate for Payer: Aetna Medicare Advantage	$115.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.22
Rate for Payer: Cigna Commercial	$192.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.07
Rate for Payer: Oxford Commercial	$192.59
Rate for Payer: Qualcare PPO/HMO/WC	$57.78
Rate for Payer: UnitedHealthcare Commercial	$192.59

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$125.31
Max. Negotiated Rate	$125.31
Rate for Payer: Qualcare PPO/HMO/WC	$125.31

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$108.60
Max. Negotiated Rate	$417.71
Rate for Payer: Aetna Commercial	$250.63
Rate for Payer: Aetna Medicare Advantage	$250.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.03
Rate for Payer: Cigna Commercial	$417.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.60
Rate for Payer: Oxford Commercial	$417.71
Rate for Payer: Qualcare PPO/HMO/WC	$125.31
Rate for Payer: UnitedHealthcare Commercial	$417.71

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$173.36
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$577.88
Rate for Payer: Aetna Commercial	$346.73
Rate for Payer: Aetna Medicare Advantage	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.72
Rate for Payer: Cigna Commercial	$577.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.25
Rate for Payer: Oxford Commercial	$577.88
Rate for Payer: Qualcare PPO/HMO/WC	$173.36
Rate for Payer: UnitedHealthcare Commercial	$577.88

IOPAMIDOL-370 50ML

Facility

$418.75

Service Code	NDC 270131630
Hospital Charge Code	606390363
Hospital Revenue Code	255
Min. Negotiated Rate	$54.44
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$125.62
Rate for Payer: Aetna Medicare Advantage	$125.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.78
Rate for Payer: Cigna Commercial	$209.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.44
Rate for Payer: Oxford Commercial	$209.38
Rate for Payer: Qualcare PPO/HMO/WC	$62.81
Rate for Payer: UnitedHealthcare Commercial	$209.38

Know your out-of-pocket cost for care.

All Charges