Heights University Hospital

All Charges

Charge

Type

Setting

Price

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
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

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
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

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
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

NCV (MOTOR) W/ F-WAVE

Facility

$285.65

Service Code	HCPCS 95903
Hospital Charge Code	5500036
Hospital Revenue Code	922
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$1,673.00
Rate for Payer: Aetna Commercial	$85.69
Rate for Payer: Aetna Medicare Advantage	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.84
Rate for Payer: Cigna Commercial	$142.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.13
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.85
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

NCV (MOTOR) W/ F-WAVE

Facility

$285.65

Service Code	HCPCS 95903
Hospital Charge Code	5500036
Hospital Revenue Code	922
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$42.85

NCV (MOTOR) W/O F-WAVE

Facility

$285.65

Service Code	HCPCS 95900
Hospital Charge Code	5500034
Hospital Revenue Code	922
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$42.85

NCV (MOTOR) W/O F-WAVE

Facility

$285.65

Service Code	HCPCS 95900
Hospital Charge Code	5500034
Hospital Revenue Code	922
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$1,673.00
Rate for Payer: Aetna Commercial	$85.69
Rate for Payer: Aetna Medicare Advantage	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.84
Rate for Payer: Cigna Commercial	$142.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.13
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.85
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$52.65
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLE ECLPSE 25GX1-1/2 305767

Facility

$0.85

Hospital Charge Code	270632923
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.13

NDLE ECLPSE 25GX1-1/2 305767

Facility

$0.85

Hospital Charge Code	270632923
Hospital Revenue Code	272
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.43
Rate for Payer: Aetna Commercial	$0.26
Rate for Payer: Aetna Medicare Advantage	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.22
Rate for Payer: Cigna Commercial	$0.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.11
Rate for Payer: Oxford Commercial	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.13
Rate for Payer: UnitedHealthcare Commercial	$0.43

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$52.65
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$52.65
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NEBCIN/1.2GM

Facility

$71.00

Hospital Charge Code	60633511
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

Know your out-of-pocket cost for care.

All Charges