Heights University Hospital

All Charges

Charge

Type

Setting

Price

ITRACONAZOLE 100 MG CAP

Facility

$44.00

Hospital Charge Code	6016257
Hospital Revenue Code	252
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

IUD INSERTION

Facility

$406.00

Service Code	HCPCS 58300
Hospital Charge Code	87502610
Hospital Revenue Code	761
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$203.00
Rate for Payer: Aetna Commercial	$121.80
Rate for Payer: Aetna Medicare Advantage	$121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.53
Rate for Payer: Cigna Commercial	$203.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.78
Rate for Payer: Oxford Commercial	$203.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.90
Rate for Payer: UnitedHealthcare Commercial	$203.00

IUD INSERTION

Facility

$406.00

Service Code	HCPCS 58300
Hospital Charge Code	87502610
Hospital Revenue Code	761
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$60.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.90

IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	87502575
Hospital Revenue Code	761
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	87502575
Hospital Revenue Code	761
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$725.69
Rate for Payer: Aetna Commercial	$200.70
Rate for Payer: Aetna Medicare Advantage	$200.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.59
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.97
Rate for Payer: Oxford Commercial	$334.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$334.50

IUD REMOVAL/PARAGARD INSERT***

Facility

$204.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600020
Hospital Revenue Code	519
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

IUD REMOVAL/PARAGARD INSERT***

Facility

$204.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600020
Hospital Revenue Code	519
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

IUD REMOVAL PROGESTASERT****

Facility

$139.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600021
Hospital Revenue Code	519
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

IUD REMOVAL PROGESTASERT****

Facility

$139.00

Service Code	HCPCS W0008WF
Hospital Charge Code	9600021
Hospital Revenue Code	519
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

IUD REMOVAL WHC******

Facility

$18.04

Service Code	HCPCS 58301
Hospital Charge Code	9600022
Hospital Revenue Code	519
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

IUD REMOVAL WHC******

Facility

$18.04

Service Code	HCPCS 58301
Hospital Charge Code	9600022
Hospital Revenue Code	519
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$725.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35

IV4 VACC NO PRSV 0.25 ML IM

Facility

$83.65

Service Code	HCPCS 90685
Hospital Charge Code	412390685
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$25.09
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IV4 VACC NO PRSV 0.25 ML IM

Facility

$83.65

Service Code	HCPCS 90685
Hospital Charge Code	412390685
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IV .9% NACL 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650211
Hospital Revenue Code	258
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

IV .9% NACL 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650211
Hospital Revenue Code	258
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

IV .9% NACL 50ML SINGLE

Facility

$10.80

Hospital Charge Code	270650212
Hospital Revenue Code	258
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

IV .9% NACL 50ML SINGLE

Facility

$10.80

Hospital Charge Code	270650212
Hospital Revenue Code	258
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$5.40

IV ARM 3X1 SUPPORT NEO LATEX F

Facility

$2,412.60

Hospital Charge Code	270664489
Hospital Revenue Code	270
Min. Negotiated Rate	$313.64
Max. Negotiated Rate	$1,206.30
Rate for Payer: Aetna Commercial	$723.78
Rate for Payer: Aetna Medicare Advantage	$723.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$615.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$615.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$615.21
Rate for Payer: Cigna Commercial	$1,206.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.64
Rate for Payer: Oxford Commercial	$1,206.30
Rate for Payer: Qualcare PPO/HMO/WC	$361.89
Rate for Payer: UnitedHealthcare Commercial	$1,206.30

IV ARM 3X1 SUPPORT NEO LATEX F

Facility

$2,412.60

Hospital Charge Code	270664489
Hospital Revenue Code	270
Min. Negotiated Rate	$361.89
Max. Negotiated Rate	$361.89
Rate for Payer: Qualcare PPO/HMO/WC	$361.89

IV ARM 3X2 SUPPORT INFANT LATE

Facility

$1,866.90

Hospital Charge Code	270664448
Hospital Revenue Code	270
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$280.04
Rate for Payer: Qualcare PPO/HMO/WC	$280.04

IV ARM 3X2 SUPPORT INFANT LATE

Facility

$1,866.90

Hospital Charge Code	270664448
Hospital Revenue Code	270
Min. Negotiated Rate	$242.70
Max. Negotiated Rate	$933.45
Rate for Payer: Aetna Commercial	$560.07
Rate for Payer: Aetna Medicare Advantage	$560.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.06
Rate for Payer: Cigna Commercial	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.70
Rate for Payer: Oxford Commercial	$933.45
Rate for Payer: Qualcare PPO/HMO/WC	$280.04
Rate for Payer: UnitedHealthcare Commercial	$933.45

IV ARM SUPPORT PED LATEX FREE

Facility

$13.40

Hospital Charge Code	270658702
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.42
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.01
Rate for Payer: UnitedHealthcare Commercial	$6.70

IV ARM SUPPORT PED LATEX FREE

Facility

$13.40

Hospital Charge Code	270658702
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.01

IVAS INFLATABLE VERTEBRAL

Facility

$8,000.00

Hospital Charge Code	270644958
Hospital Revenue Code	270
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

IVAS INFLATABLE VERTEBRAL

Facility

$8,000.00

Hospital Charge Code	270644958
Hospital Revenue Code	270
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.00
Rate for Payer: Oxford Commercial	$4,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Commercial	$4,000.00

Know your out-of-pocket cost for care.

All Charges