Heights University Hospital

All Charges

Charge

Type

Setting

Price

Apixaban 5mg tab

Facility

$42.21

Service Code	NDC 3089431
Hospital Charge Code	6000435
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.49
Rate for Payer: Oxford Commercial	$21.11
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$21.11

Apixaban 5mg tab

Facility

$42.21

Service Code	NDC 3089431
Hospital Charge Code	6000435
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

APLIGRAF 44 SQ CM

Facility

$7,570.00

Hospital Charge Code	270619908W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,135.50
Max. Negotiated Rate	$1,831.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,831.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,135.50

APLIGRAF 44 SQ CM

Facility

$7,570.00

Hospital Charge Code	270619908W
Hospital Revenue Code	636
Min. Negotiated Rate	$1,135.50
Max. Negotiated Rate	$3,785.00
Rate for Payer: Aetna Commercial	$2,271.00
Rate for Payer: Aetna Medicare Advantage	$2,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,930.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,930.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,930.35
Rate for Payer: Cigna Commercial	$3,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,831.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,135.50

APLIGRAF 7.5CM

Facility

$6,475.00

Service Code	HCPCS Q4101
Hospital Charge Code	270619908
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

APLIGRAF 7.5CM

Facility

$6,475.00

Service Code	HCPCS Q4101
Hospital Charge Code	270619908
Hospital Revenue Code	636
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

APLIGRAFT TISSUE 199

Facility

$11,083.30

Service Code	HCPCS Q4101
Hospital Charge Code	270655637
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,324.99
Rate for Payer: Aetna Commercial	$3,324.99
Rate for Payer: Aetna Medicare Advantage	$3,324.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,826.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,826.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,826.24
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.49

APLIGRAFT TISSUE 199

Facility

$11,083.30

Service Code	HCPCS Q4101
Hospital Charge Code	270655637
Hospital Revenue Code	636
Min. Negotiated Rate	$1,662.49
Max. Negotiated Rate	$2,682.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.49

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

APLISOL 5TU 10 TEST VIAL PPD

Facility

$4.00

Hospital Charge Code	83652549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632473
Hospital Revenue Code	250
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$34.50

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632473
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632474
Hospital Revenue Code	250
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$34.50

APLISOL/5U/0.1ML

Facility

$69.00

Hospital Charge Code	60632474
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

APLY BNE FIXATION DEVC>1 PLANE

Facility

$30,595.00

Service Code	HCPCS 20692
Hospital Charge Code	1600000412
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

APLY BNE FIXATION DEVC>1 PLANE

Facility

$30,595.00

Service Code	HCPCS 20692
Hospital Charge Code	1600000412
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$34,593.91
Rate for Payer: Aetna Better Health Medicaid	$33,915.60
Rate for Payer: Aetna Commercial	$9,178.50
Rate for Payer: Aetna Medicare Advantage	$9,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,801.73
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	$7,801.73
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,593.91
Rate for Payer: Wellpoint Medicaid Managed Care	$33,915.60

APLY BNE FIXATION DEVC 1PLANE

Facility

$30,595.00

Service Code	HCPCS 20690
Hospital Charge Code	16000372
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

APLY BNE FIXATION DEVC 1PLANE

Facility

$30,595.00

Service Code	HCPCS 20690
Hospital Charge Code	16000372
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Better Health Medicaid	$15,569.19
Rate for Payer: Aetna Commercial	$9,178.50
Rate for Payer: Aetna Medicare Advantage	$9,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,801.73
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	$7,801.73
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57
Rate for Payer: Wellpoint Medicaid Managed Care	$15,569.19

APLY SPINE PROSTH DEVICE

Facility

$23,774.45

Service Code	HCPCS 22853
Hospital Charge Code	16000242
Hospital Revenue Code	360
Min. Negotiated Rate	$247.90
Max. Negotiated Rate	$7,132.34
Rate for Payer: Aetna Commercial	$7,132.34
Rate for Payer: Aetna Medicare Advantage	$7,132.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,062.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,062.48
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	$6,062.48
Rate for Payer: Cigna Commercial	$247.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,090.68
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

APLY SPINE PROSTH DEVICE

Facility

$23,774.45

Service Code	HCPCS 22853
Hospital Charge Code	16000242
Hospital Revenue Code	360
Min. Negotiated Rate	$3,566.17
Max. Negotiated Rate	$3,566.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.17

APO A1 + B I

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527A
Hospital Revenue Code	300
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.33
Rate for Payer: Aetna Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$21.09
Rate for Payer: Cigna Medicare Advantage	$10.54
Rate for Payer: Clover Medicare Advantage	$20.04
Rate for Payer: EmblemHealth Commercial	$63.27
Rate for Payer: Humana Medicare Advantage	$21.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.36
Rate for Payer: Wellcare Medicare Advantage	$21.09

APO A1 + B I

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527A
Hospital Revenue Code	300
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

APO A1 + B II

Facility

$205.65

Service Code	HCPCS 82172
Hospital Charge Code	3038527B
Hospital Revenue Code	300
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

Know your out-of-pocket cost for care.

All Charges