Heights University Hospital

All Charges

Charge

Type

Setting

Price

MOBILITY GOAL STATUS CK

Facility

$0.01

Service Code	HCPCS G8979GOCK
Hospital Charge Code	74203089CK
Hospital Revenue Code	430
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8979GPCL
Hospital Charge Code	84202005CL
Hospital Revenue Code	420
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8979GOCL
Hospital Charge Code	74203089CL
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8979GPCL
Hospital Charge Code	84202005CL
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8979GOCL
Hospital Charge Code	74203089CL
Hospital Revenue Code	430
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8979GPCM
Hospital Charge Code	84202005CM
Hospital Revenue Code	420
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8979GOCM
Hospital Charge Code	74203089CM
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8979GOCM
Hospital Charge Code	74203089CM
Hospital Revenue Code	430
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8979GPCM
Hospital Charge Code	84202005CM
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8979GPCN
Hospital Charge Code	84202005CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8979GOCN
Hospital Charge Code	74203089CN
Hospital Revenue Code	430
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8979GPCN
Hospital Charge Code	84202005CN
Hospital Revenue Code	420
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

MOBILITY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8979GOCN
Hospital Charge Code	74203089CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOC31 CMA974

Facility

$1,750.00

Hospital Charge Code	270654933
Hospital Revenue Code	270
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$875.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$875.00

MOC31 CMA974

Facility

$1,750.00

Hospital Charge Code	270654933
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

MODAFINIL 100 MG TAB

Facility

$147.87

Service Code	NDC 55253080130
Hospital Charge Code	60629289
Hospital Revenue Code	259
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$73.94
Rate for Payer: Aetna Commercial	$44.36
Rate for Payer: Aetna Medicare Advantage	$44.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.71
Rate for Payer: Cigna Commercial	$73.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.22
Rate for Payer: Oxford Commercial	$73.94
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$73.94

MODAFINIL 100 MG TAB

Facility

$147.87

Service Code	NDC 55253080130
Hospital Charge Code	60629289
Hospital Revenue Code	259
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

MODAFINIL 200MG TABLET

Facility

$23.70

Hospital Charge Code	60629213
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

MODAFINIL 200MG TABLET

Facility

$23.70

Hospital Charge Code	60629213
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: Aetna Medicare Advantage	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.04
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.08
Rate for Payer: Oxford Commercial	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$3.56
Rate for Payer: UnitedHealthcare Commercial	$11.85

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$16,293.75
Max. Negotiated Rate	$26,287.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$16,293.75
Max. Negotiated Rate	$54,312.50
Rate for Payer: Aetna Commercial	$32,587.50
Rate for Payer: Aetna Medicare Advantage	$32,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,699.38
Rate for Payer: Cigna Commercial	$54,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$318.00

Know your out-of-pocket cost for care.

All Charges