Heights University Hospital

All Charges

Charge

Type

Setting

Price

IOTHALAMATE INJ 60%

Facility

$25.60

Hospital Charge Code	60627881
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

IOTHALAMATE INJ 60%

Facility

$25.60

Hospital Charge Code	60627881
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

IOTHALAMATE MEGLUMINE 500 ML

Facility

$160.65

Hospital Charge Code	6012686
Hospital Revenue Code	250
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Qualcare PPO/HMO/WC	$24.10

IOTHALAMATE MEGLUMINE 500 ML

Facility

$160.65

Hospital Charge Code	6012686
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$80.33
Rate for Payer: Aetna Commercial	$48.20
Rate for Payer: Aetna Medicare Advantage	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.97
Rate for Payer: Cigna Commercial	$80.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.88
Rate for Payer: Oxford Commercial	$80.33
Rate for Payer: Qualcare PPO/HMO/WC	$24.10
Rate for Payer: UnitedHealthcare Commercial	$80.33

IOTHALAMATE MEGLUM SOL 17.2%

Facility

$290.60

Hospital Charge Code	6003156
Hospital Revenue Code	250
Min. Negotiated Rate	$43.59
Max. Negotiated Rate	$43.59
Rate for Payer: Qualcare PPO/HMO/WC	$43.59

IOTHALAMATE MEGLUM SOL 17.2%

Facility

$290.60

Hospital Charge Code	6003156
Hospital Revenue Code	250
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$145.30
Rate for Payer: Aetna Commercial	$87.18
Rate for Payer: Aetna Medicare Advantage	$87.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.10
Rate for Payer: Cigna Commercial	$145.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.78
Rate for Payer: Oxford Commercial	$145.30
Rate for Payer: Qualcare PPO/HMO/WC	$43.59
Rate for Payer: UnitedHealthcare Commercial	$145.30

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$387.40
Max. Negotiated Rate	$1,490.00
Rate for Payer: Aetna Commercial	$894.00
Rate for Payer: Aetna Medicare Advantage	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.90
Rate for Payer: Cigna Commercial	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.40
Rate for Payer: Oxford Commercial	$1,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00
Rate for Payer: UnitedHealthcare Commercial	$1,490.00

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

IPECAC/30CC

Facility

$7.00

Hospital Charge Code	60634576
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

IPECAC/30CC

Facility

$7.00

Hospital Charge Code	60634576
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

IPECAC/30ML

Facility

$8.00

Hospital Charge Code	60633192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

IPECAC/30ML

Facility

$8.00

Hospital Charge Code	60633192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

IPECAC SYRUP

Facility

$13.45

Hospital Charge Code	60628140
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

IPECAC SYRUP

Facility

$13.45

Hospital Charge Code	60628140
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$6.72
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$6.72

IPECAC SYRUP 30ML

Facility

$37.80

Hospital Charge Code	6003164
Hospital Revenue Code	251
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

IPECAC SYRUP 30ML

Facility

$37.80

Hospital Charge Code	6003164
Hospital Revenue Code	251
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$18,000.00
Max. Negotiated Rate	$60,000.00
Rate for Payer: Aetna Commercial	$36,000.00
Rate for Payer: Aetna Medicare Advantage	$36,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,600.00
Rate for Payer: Cigna Commercial	$60,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$18,000.00
Max. Negotiated Rate	$29,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$19,500.00
Max. Negotiated Rate	$65,000.00
Rate for Payer: Aetna Commercial	$39,000.00
Rate for Payer: Aetna Medicare Advantage	$39,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,150.00
Rate for Payer: Cigna Commercial	$65,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$19,500.00
Max. Negotiated Rate	$31,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$7,050.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

IPPB TREATMENT W/WO MED

Facility

$154.25

Service Code	HCPCS 94664
Hospital Charge Code	9500109
Hospital Revenue Code	410
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$46.27
Rate for Payer: Aetna Medicare Advantage	$46.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.33
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.05
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.14
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

Know your out-of-pocket cost for care.

All Charges