Heights University Hospital

All Charges

Charge

Type

Setting

Price

MODERNACOV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0064A
Hospital Charge Code	39500064A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0011A
Hospital Charge Code	39500011A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0011A
Hospital Charge Code	39500011A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COVID19 VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0012A
Hospital Charge Code	39500012A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COVID19 VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0012A
Hospital Charge Code	39500012A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0013A
Hospital Charge Code	39500013A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COVID19 VACC ADM DOSE3

Facility

$50.00

Service Code	HCPCS 0013A
Hospital Charge Code	39500013A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	40100064A
Hospital Revenue Code	771
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$43.61
Rate for Payer: Aetna Medicare Advantage	$43.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.07
Rate for Payer: Cigna Commercial	$72.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.81
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	31700064A
Hospital Revenue Code	771
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$43.61
Rate for Payer: Aetna Medicare Advantage	$43.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.07
Rate for Payer: Cigna Commercial	$72.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.90
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.81
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	40100064A
Hospital Revenue Code	771
Min. Negotiated Rate	$21.81
Max. Negotiated Rate	$21.81
Rate for Payer: Qualcare PPO/HMO/WC	$21.81

MODERNA COVID19 VACC BOOSTER

Facility

$145.38

Service Code	HCPCS 0064A
Hospital Charge Code	31700064A
Hospital Revenue Code	771
Min. Negotiated Rate	$21.81
Max. Negotiated Rate	$21.81
Rate for Payer: Qualcare PPO/HMO/WC	$21.81

MOD HAND INSERTER

Facility

$3,756.00

Hospital Charge Code	270656690
Hospital Revenue Code	272
Min. Negotiated Rate	$488.28
Max. Negotiated Rate	$1,878.00
Rate for Payer: Aetna Commercial	$1,126.80
Rate for Payer: Aetna Medicare Advantage	$1,126.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$957.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$957.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$957.78
Rate for Payer: Cigna Commercial	$1,878.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.28
Rate for Payer: Oxford Commercial	$1,878.00
Rate for Payer: Qualcare PPO/HMO/WC	$563.40
Rate for Payer: UnitedHealthcare Commercial	$1,878.00

MOD HAND INSERTER

Facility

$3,756.00

Hospital Charge Code	270656690
Hospital Revenue Code	272
Min. Negotiated Rate	$563.40
Max. Negotiated Rate	$563.40
Rate for Payer: Qualcare PPO/HMO/WC	$563.40

MOD HEAD-VARIABLE ONSET 42X21X

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Charge Code	270705538
Hospital Revenue Code	278
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$875.50
Rate for Payer: Aetna Commercial	$525.30
Rate for Payer: Aetna Medicare Advantage	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.50
Rate for Payer: Cigna Commercial	$875.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.74
Rate for Payer: Qualcare PPO/HMO/WC	$262.65

MOD HEAD-VARIABLE ONSET 42X21X

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Charge Code	270705538
Hospital Revenue Code	278
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$423.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.74
Rate for Payer: Qualcare PPO/HMO/WC	$262.65

MOD HOOK 4FR 65CM

Facility

$58.50

Hospital Charge Code	270657618N
Hospital Revenue Code	272
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$17.55
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.92
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.61
Rate for Payer: Oxford Commercial	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.78
Rate for Payer: UnitedHealthcare Commercial	$29.25

MOD HOOK 4FR 65CM

Facility

$58.50

Hospital Charge Code	270657618N
Hospital Revenue Code	272
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$8.78
Rate for Payer: Qualcare PPO/HMO/WC	$8.78

MOD HOOK 4FR 65CM

Facility

$558.50

Hospital Charge Code	270657618S
Hospital Revenue Code	272
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$83.78
Rate for Payer: Qualcare PPO/HMO/WC	$83.78

MOD HOOK 4FR 65CM

Facility

$558.50

Hospital Charge Code	270657618S
Hospital Revenue Code	272
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$279.25
Rate for Payer: Aetna Commercial	$167.55
Rate for Payer: Aetna Medicare Advantage	$167.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.42
Rate for Payer: Cigna Commercial	$279.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.61
Rate for Payer: Oxford Commercial	$279.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.78
Rate for Payer: UnitedHealthcare Commercial	$279.25

MODIFIED DAKINS SOLN 1/2 STREN

Facility

$10.90

Hospital Charge Code	60628545
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

MODIFIED DAKINS SOLN 1/2 STREN

Facility

$10.90

Hospital Charge Code	60628545
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

MODIFIED DAKINS SOLN 1/4 STREN

Facility

$9.00

Hospital Charge Code	60628546
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

MODIFIED DAKINS SOLN 1/4 STREN

Facility

$9.00

Hospital Charge Code	60628546
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

MODIFIED DAKINS SOLN FULLSTREN

Facility

$9.00

Hospital Charge Code	60628547
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

MODIFIED DAKINS SOLN FULLSTREN

Facility

$9.00

Hospital Charge Code	60628547
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

Know your out-of-pocket cost for care.

All Charges