Heights University Hospital

All Charges

Charge

Type

Setting

Price

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094H
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094H
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

ARBOVIRUS ENCEPHALITIS ABS IGG

Facility

$67.25

Service Code	HCPCS 86651
Hospital Charge Code	3001749
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

ARBOVIRUS ENCEPHALITIS ABS IGG

Facility

$67.25

Service Code	HCPCS 86651
Hospital Charge Code	3001749
Hospital Revenue Code	302
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

ARCH SUPPORT

Facility

$1,105.00

Hospital Charge Code	270629690
Hospital Revenue Code	270
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$165.75
Rate for Payer: Qualcare PPO/HMO/WC	$165.75

ARCH SUPPORT

Facility

$1,105.00

Hospital Charge Code	270629690
Hospital Revenue Code	270
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$552.50
Rate for Payer: Aetna Commercial	$331.50
Rate for Payer: Aetna Medicare Advantage	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.77
Rate for Payer: Cigna Commercial	$552.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.65
Rate for Payer: Oxford Commercial	$552.50
Rate for Payer: Qualcare PPO/HMO/WC	$165.75
Rate for Payer: UnitedHealthcare Commercial	$552.50

ARCOM XL 28 X 38MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688599
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ARCOM XL 28 X 38MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688599
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ARCOS 16X150MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686540
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 16X150MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686540
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$5,598.00
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 17X200MM CYL DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270688683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 17X200MM CYL DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270688683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$5,598.00
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 18X190MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$5,598.00
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 18X190MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 1PC 18X210MM+0CALC STD

Facility

$37,495.00

Hospital Charge Code	270702527
Hospital Revenue Code	278
Min. Negotiated Rate	$5,624.25
Max. Negotiated Rate	$18,747.50
Rate for Payer: Aetna Commercial	$11,248.50
Rate for Payer: Aetna Medicare Advantage	$11,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,561.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,561.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,561.23
Rate for Payer: Cigna Commercial	$18,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,073.79
Rate for Payer: Qualcare PPO/HMO/WC	$5,624.25

ARCOS 1PC 18X210MM+0CALC STD

Facility

$37,495.00

Hospital Charge Code	270702527
Hospital Revenue Code	278
Min. Negotiated Rate	$5,624.25
Max. Negotiated Rate	$9,073.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,073.79
Rate for Payer: Qualcare PPO/HMO/WC	$5,624.25

ARCOS CON CON SZ A HI 50MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270686541
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$10,863.00
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

ARCOS CON CON SZ A HI 50MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270686541
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

ARCOS CON SZ A STD 50MM

Facility

$39,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675924
Hospital Revenue Code	278
Min. Negotiated Rate	$5,913.00
Max. Negotiated Rate	$9,539.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,884.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,539.64
Rate for Payer: Qualcare PPO/HMO/WC	$5,913.00

ARCOS CON SZ A STD 50MM

Facility

$39,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675924
Hospital Revenue Code	278
Min. Negotiated Rate	$5,913.00
Max. Negotiated Rate	$19,710.00
Rate for Payer: Aetna Commercial	$11,826.00
Rate for Payer: Aetna Medicare Advantage	$11,826.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,052.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,052.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,052.10
Rate for Payer: Cigna Commercial	$19,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,539.64
Rate for Payer: Qualcare PPO/HMO/WC	$5,913.00

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703563
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703563
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703550
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703550
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$1,980.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

ARDVAN INJ/10MG/10ML VIAL

Facility

$238.00

Hospital Charge Code	60634313
Hospital Revenue Code	250
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

Know your out-of-pocket cost for care.

All Charges