Heights University Hospital

All Charges

Charge

Type

Setting

Price

NEURONTIN/300MG

Facility

$3.00

Hospital Charge Code	60634964
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.76

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.21
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.76
Rate for Payer: UnitedHealthcare Commercial	$9.21

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$4,931.10
Rate for Payer: Aetna Medicare Advantage	$4,931.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,191.44
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,136.81
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$2,675.48
Max. Negotiated Rate	$2,675.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$5,350.97
Rate for Payer: Aetna Medicare Advantage	$5,350.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,548.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,548.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,548.32
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,318.75
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$4,931.10
Rate for Payer: Aetna Medicare Advantage	$4,931.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,191.44
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,136.81
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$4,931.10
Rate for Payer: Aetna Medicare Advantage	$4,931.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,191.44
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,136.81
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$5,656.36
Max. Negotiated Rate	$5,656.36
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,898.76
Rate for Payer: Aetna Commercial	$11,312.73
Rate for Payer: Aetna Medicare Advantage	$11,312.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,615.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,615.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,615.82
Rate for Payer: Cigna Commercial	$20,898.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,902.18
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

NEUROSES EXCEPT DEPRESSIVE

Facility

$42,990.06

Service Code	MSDRG 882
Min. Negotiated Rate	$11,717.93
Max. Negotiated Rate	$42,990.06
Rate for Payer: Aetna Commercial	$36,208.40
Rate for Payer: Aetna Medicare Advantage	$11,717.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,912.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,912.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,330.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,912.98
Rate for Payer: Cigna Commercial	$23,109.25
Rate for Payer: Cigna Medicare Advantage	$14,330.02
Rate for Payer: Clover Medicare Advantage	$13,613.52
Rate for Payer: EmblemHealth Commercial	$42,990.06
Rate for Payer: Humana Medicare Advantage	$14,759.92
Rate for Payer: Oxford Commercial	$14,442.61
Rate for Payer: UnitedHealthcare Commercial	$16,393.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,330.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,189.82
Rate for Payer: Wellcare Medicare Advantage	$14,330.02

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$9,112.50
Max. Negotiated Rate	$14,701.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$9,112.50
Max. Negotiated Rate	$30,375.00
Rate for Payer: Aetna Commercial	$18,225.00
Rate for Payer: Aetna Medicare Advantage	$18,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,491.25
Rate for Payer: Cigna Commercial	$30,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$56,250.00
Rate for Payer: Aetna Commercial	$33,750.00
Rate for Payer: Aetna Medicare Advantage	$33,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,687.50
Rate for Payer: Cigna Commercial	$56,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$27,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$8,587.50
Max. Negotiated Rate	$13,854.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$8,587.50
Max. Negotiated Rate	$28,625.00
Rate for Payer: Aetna Commercial	$17,175.00
Rate for Payer: Aetna Medicare Advantage	$17,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,598.75
Rate for Payer: Cigna Commercial	$28,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

NEUROTHERM ELECTRODE

Facility

$525.00

Hospital Charge Code	270339098
Hospital Revenue Code	272
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$157.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.25
Rate for Payer: Oxford Commercial	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$262.50

Know your out-of-pocket cost for care.

All Charges