Heights University Hospital

All Charges

Charge

Type

Setting

Price

AXIONICS PNE LEAD I 1901

Facility

$200.00

Service Code	HCPCS C1778
Hospital Charge Code	270702028
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

AXIONICS PNE LEAD IMPLANT KIT.

Facility

$1,300.00

Service Code	HCPCS C1778
Hospital Charge Code	270702027
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$390.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

AXIONICS PNE LEAD IMPLANT KIT.

Facility

$1,300.00

Service Code	HCPCS C1778
Hospital Charge Code	270702027
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

AXIONICS TINED LEAD KIT. I.

Facility

$17,500.00

Hospital Charge Code	270702119
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

AXIONICS TINED LEAD KIT. I.

Facility

$17,500.00

Hospital Charge Code	270702119
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

AXIOS STENT 20X10MM

Facility

$22,750.00

Service Code	HCPCS C1874
Hospital Charge Code	270686630
Hospital Revenue Code	278
Min. Negotiated Rate	$3,412.50
Max. Negotiated Rate	$11,375.00
Rate for Payer: Aetna Commercial	$6,825.00
Rate for Payer: Aetna Medicare Advantage	$6,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,801.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,801.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,801.25
Rate for Payer: Cigna Commercial	$11,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,505.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,412.50

AXIOS STENT 20X10MM

Facility

$22,750.00

Service Code	HCPCS C1874
Hospital Charge Code	270686630
Hospital Revenue Code	278
Min. Negotiated Rate	$3,412.50
Max. Negotiated Rate	$5,505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,505.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,412.50

AXLE PROSTHESIS HIP

Facility

$2,440.00

Service Code	HCPCS C1776
Hospital Charge Code	270638565
Hospital Revenue Code	278
Min. Negotiated Rate	$366.00
Max. Negotiated Rate	$590.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.48
Rate for Payer: Qualcare PPO/HMO/WC	$366.00

AXLE PROSTHESIS HIP

Facility

$2,440.00

Service Code	HCPCS C1776
Hospital Charge Code	270638565
Hospital Revenue Code	278
Min. Negotiated Rate	$366.00
Max. Negotiated Rate	$1,220.00
Rate for Payer: Aetna Commercial	$732.00
Rate for Payer: Aetna Medicare Advantage	$732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$622.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$622.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$622.20
Rate for Payer: Cigna Commercial	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.48
Rate for Payer: Qualcare PPO/HMO/WC	$366.00

AXLE RS OSS

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270667949
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,080.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

AXLE RS OSS

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270667949
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

AXOTAL/TAB

Facility

$3.00

Hospital Charge Code	60632517
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AXOTAL/TAB

Facility

$3.00

Hospital Charge Code	60632517
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

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$3,442.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.75
Rate for Payer: Oxford Commercial	$5,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$5,737.50

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$3,442.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.75
Rate for Payer: Oxford Commercial	$5,737.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$5,737.50

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$275.10
Rate for Payer: Qualcare PPO/HMO/WC	$275.10

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$200.78
Max. Negotiated Rate	$550.20
Rate for Payer: Aetna Commercial	$550.20
Rate for Payer: Aetna Medicare Advantage	$550.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$467.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$467.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$467.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.42
Rate for Payer: Qualcare PPO/HMO/WC	$275.10

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.01
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.01

AYR BABY SALINE

Facility

$9.56

Hospital Charge Code	60635816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.78

AYR BABY SALINE

Facility

$9.56

Hospital Charge Code	60635816
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

AZACITIDINE 100 MG REC

Facility

$2,941.15

Hospital Charge Code	60629945A
Hospital Revenue Code	636
Min. Negotiated Rate	$441.17
Max. Negotiated Rate	$1,470.58
Rate for Payer: Aetna Commercial	$882.35
Rate for Payer: Aetna Medicare Advantage	$882.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$749.99
Rate for Payer: Cigna Commercial	$1,470.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.76
Rate for Payer: Qualcare PPO/HMO/WC	$441.17

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1,411.60
Rate for Payer: Aetna Commercial	$1,411.60
Rate for Payer: Aetna Medicare Advantage	$1,411.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.86
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80

Know your out-of-pocket cost for care.

All Charges