Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT NANONEEDLE HIGHFLOW 125MM

Facility

$960.00

Service Code	HCPCS A4649
Hospital Charge Code	270699065
Hospital Revenue Code	272
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.00

KIT NERVE BLOCK 22X8

Facility

$75.35

Hospital Charge Code	270669572
Hospital Revenue Code	272
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$37.67
Rate for Payer: Aetna Commercial	$22.61
Rate for Payer: Aetna Medicare Advantage	$22.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.21
Rate for Payer: Cigna Commercial	$37.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.80
Rate for Payer: Oxford Commercial	$37.67
Rate for Payer: Qualcare PPO/HMO/WC	$11.30
Rate for Payer: UnitedHealthcare Commercial	$37.67

KIT NERVE BLOCK 22X8

Facility

$75.35

Hospital Charge Code	270669572
Hospital Revenue Code	272
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$11.30
Rate for Payer: Qualcare PPO/HMO/WC	$11.30

KIT NERVE STIM NERVEANA DRAGON

Facility

$5,750.00

Service Code	HCPCS A4649
Hospital Charge Code	270695163
Hospital Revenue Code	272
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

KIT NERVE STIM NERVEANA DRAGON

Facility

$5,750.00

Service Code	HCPCS A4649
Hospital Charge Code	270695163
Hospital Revenue Code	272
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$1,725.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.50
Rate for Payer: Oxford Commercial	$2,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$2,875.00

KIT OB TAPE PROCED OBRT 934300

Facility

$4,960.00

Hospital Charge Code	270634440
Hospital Revenue Code	272
Min. Negotiated Rate	$644.80
Max. Negotiated Rate	$2,480.00
Rate for Payer: Aetna Commercial	$1,488.00
Rate for Payer: Aetna Medicare Advantage	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,264.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,264.80
Rate for Payer: Cigna Commercial	$2,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$644.80
Rate for Payer: Oxford Commercial	$2,480.00
Rate for Payer: Qualcare PPO/HMO/WC	$744.00
Rate for Payer: UnitedHealthcare Commercial	$2,480.00

KIT OB TAPE PROCED OBRT 934300

Facility

$4,960.00

Hospital Charge Code	270634440
Hospital Revenue Code	272
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$744.00
Rate for Payer: Qualcare PPO/HMO/WC	$744.00

KIT ONYX 18 AVM

Facility

$15,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270685187S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$7,737.50
Rate for Payer: Aetna Commercial	$4,642.50
Rate for Payer: Aetna Medicare Advantage	$4,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,946.12
Rate for Payer: Cigna Commercial	$7,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT ONYX 18 AVM

Facility

$15,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270685187S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT ONYX 18 AVM

Facility

$15,475.00

Service Code	HCPCS C1887
Hospital Charge Code	270685187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT ONYX 18 AVM

Facility

$15,475.00

Service Code	HCPCS C1887
Hospital Charge Code	270685187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$7,737.50
Rate for Payer: Aetna Commercial	$4,642.50
Rate for Payer: Aetna Medicare Advantage	$4,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,946.12
Rate for Payer: Cigna Commercial	$7,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT ONYX 34 AVM US

Facility

$15,475.00

Service Code	HCPCS C1887
Hospital Charge Code	270685188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$7,737.50
Rate for Payer: Aetna Commercial	$4,642.50
Rate for Payer: Aetna Medicare Advantage	$4,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,946.12
Rate for Payer: Cigna Commercial	$7,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT ONYX 34 AVM US

Facility

$15,475.00

Service Code	HCPCS C1887
Hospital Charge Code	270685188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

KIT OPTIVAC 41700

Facility

$850.00

Hospital Charge Code	270629379
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

KIT OPTIVAC 41700

Facility

$850.00

Hospital Charge Code	270629379
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

KIT OPTIVAC 80G CEMENT 417800

Facility

$755.25

Hospital Charge Code	270621912
Hospital Revenue Code	272
Min. Negotiated Rate	$98.18
Max. Negotiated Rate	$377.62
Rate for Payer: Aetna Commercial	$226.57
Rate for Payer: Aetna Medicare Advantage	$226.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.59
Rate for Payer: Cigna Commercial	$377.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.18
Rate for Payer: Oxford Commercial	$377.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.29
Rate for Payer: UnitedHealthcare Commercial	$377.62

KIT OPTIVAC 80G CEMENT 417800

Facility

$755.25

Hospital Charge Code	270621912
Hospital Revenue Code	272
Min. Negotiated Rate	$113.29
Max. Negotiated Rate	$113.29
Rate for Payer: Qualcare PPO/HMO/WC	$113.29

KIT OPTIVAC 80G DBL MIX 417200

Facility

$1,104.85

Hospital Charge Code	270618648
Hospital Revenue Code	272
Min. Negotiated Rate	$143.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$331.45
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.63
Rate for Payer: Oxford Commercial	$552.42
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Commercial	$552.42

KIT OPTIVAC 80G DBL MIX 417200

Facility

$1,104.85

Hospital Charge Code	270618648
Hospital Revenue Code	272
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

KIT OPTIVAC MIX HIP

Facility

$850.00

Hospital Charge Code	270621291
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

KIT OPTIVAC MIX HIP

Facility

$850.00

Hospital Charge Code	270621291
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104E
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104E
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$487.50

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$487.50

Know your out-of-pocket cost for care.

All Charges