Heights University Hospital

All Charges

Charge

Type

Setting

Price

OP OFFICE VS - LEVEL 3 NEW PT

Facility

$63.00

Service Code	HCPCS 99203
Hospital Charge Code	260103
Hospital Revenue Code	510
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$77.24
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.19
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

OP OFFICE VS - LEVEL 3 NEW PT

Facility

$63.00

Service Code	HCPCS 99203
Hospital Charge Code	260103
Hospital Revenue Code	510
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

OP OFFICE VS - LEVEL 4 EST PT

Facility

$62.00

Service Code	HCPCS 99214
Hospital Charge Code	260114
Hospital Revenue Code	510
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

OP OFFICE VS - LEVEL 4 EST PT

Facility

$62.00

Service Code	HCPCS 99214
Hospital Charge Code	260114
Hospital Revenue Code	510
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

OP OFFICE VS - LEVEL 4 NEW PT

Facility

$93.00

Service Code	HCPCS 99204
Hospital Charge Code	260104
Hospital Revenue Code	510
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

OP OFFICE VS - LEVEL 4 NEW PT

Facility

$93.00

Service Code	HCPCS 99204
Hospital Charge Code	260104
Hospital Revenue Code	510
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$126.45
Rate for Payer: Aetna Commercial	$27.90
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

OP OFFICE VS - LEVEL 5 EST PT

Facility

$91.00

Service Code	HCPCS 99215
Hospital Charge Code	260115
Hospital Revenue Code	510
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

OP OFFICE VS - LEVEL 5 EST PT

Facility

$91.00

Service Code	HCPCS 99215
Hospital Charge Code	260115
Hospital Revenue Code	510
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$135.96
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

OP OFFICE VS - LEVEL 5 NEW PT

Facility

$101.00

Service Code	HCPCS 99205
Hospital Charge Code	260105
Hospital Revenue Code	510
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

OP OFFICE VS - LEVEL 5 NEW PT

Facility

$101.00

Service Code	HCPCS 99205
Hospital Charge Code	260105
Hospital Revenue Code	510
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$25,388.29
Rate for Payer: Aetna Medicare Advantage	$25,388.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,580.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,580.04
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	$21,580.04
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,001.59
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$12,694.14
Max. Negotiated Rate	$12,694.14
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$476.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$984.10
Rate for Payer: Aetna Commercial	$590.46
Rate for Payer: Aetna Medicare Advantage	$590.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.89
Rate for Payer: Cigna Commercial	$984.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23

OPRELVEKIN 5MG VIAL

Facility

$843.00

Hospital Charge Code	60635207
Hospital Revenue Code	636
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$204.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

OPRELVEKIN 5MG VIAL

Facility

$843.00

Hospital Charge Code	60635207
Hospital Revenue Code	636
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$421.50
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

OPSITE *********

Facility

$55.00

Hospital Charge Code	8001190
Hospital Revenue Code	279
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

OPSITE *********

Facility

$55.00

Hospital Charge Code	8001190
Hospital Revenue Code	279
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$16.50
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.15
Rate for Payer: Oxford Commercial	$27.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$27.50

O&P SMEAR PRIM SOURCE W INTERP

Facility

$107.00

Service Code	HCPCS 87209
Hospital Charge Code	3035156B
Hospital Revenue Code	309
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

O&P SMEAR PRIM SOURCE W INTERP

Facility

$107.00

Service Code	HCPCS 87209
Hospital Charge Code	3035156B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

OPTEFIL 1CC SYRINGE

Facility

$624.00

Hospital Charge Code	270332652
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$151.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

OPTEFIL 1CC SYRINGE

Facility

$624.00

Hospital Charge Code	270332652
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$187.20
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1762
Hospital Charge Code	270674250
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$495.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1762
Hospital Charge Code	270674250
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270681387
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$495.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

Know your out-of-pocket cost for care.

All Charges