Heights University Hospital

All Charges

Charge

Type

Setting

Price

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$48.92
Max. Negotiated Rate	$188.13
Rate for Payer: Aetna Commercial	$112.88
Rate for Payer: Aetna Medicare Advantage	$112.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.95
Rate for Payer: Cigna Commercial	$188.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.92
Rate for Payer: Oxford Commercial	$188.13
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$188.13

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627S
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

Optisphere Embolic Bds 300-500

Facility

$1,200.00

Hospital Charge Code	270686627N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

OPTI VISOR MP300 MP300

Facility

$74.45

Hospital Charge Code	270635629
Hospital Revenue Code	272
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

OPTI VISOR MP300 MP300

Facility

$74.45

Hospital Charge Code	270635629
Hospital Revenue Code	272
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$22.34
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$37.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: Oxford Commercial	$37.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.17
Rate for Payer: UnitedHealthcare Commercial	$37.23

OP TX ACLAV DISLOC ACUTE/CHRON

Facility

$48,992.10

Service Code	HCPCS 23550
Hospital Charge Code	16000612
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$14,697.63
Rate for Payer: Aetna Medicare Advantage	$14,697.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,492.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,492.99
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	$12,492.99
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,368.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OP TX ACLAV DISLOC ACUTE/CHRON

Facility

$48,992.10

Service Code	HCPCS 23550
Hospital Charge Code	16000612
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OP TX COMPL CRAN NRV FX W INT

Facility

$20,756.28

Service Code	HCPCS 21365
Hospital Charge Code	1600000640
Hospital Revenue Code	360
Min. Negotiated Rate	$3,113.44
Max. Negotiated Rate	$3,113.44
Rate for Payer: Qualcare PPO/HMO/WC	$3,113.44

OP TX COMPL CRAN NRV FX W INT

Facility

$20,756.28

Service Code	HCPCS 21365
Hospital Charge Code	1600000640
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Commercial	$6,226.88
Rate for Payer: Aetna Medicare Advantage	$6,226.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,292.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,292.85
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	$5,292.85
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,698.32
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,113.44
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

OP TX FEM SFT FX W US EXAM

Facility

$15,091.30

Service Code	HCPCS 27506
Hospital Charge Code	1600000326
Hospital Revenue Code	360
Min. Negotiated Rate	$2,263.70
Max. Negotiated Rate	$2,263.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,263.70

OP TX FEM SFT FX W US EXAM

Facility

$15,091.30

Service Code	HCPCS 27506
Hospital Charge Code	1600000326
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$4,527.39
Rate for Payer: Aetna Medicare Advantage	$4,527.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,848.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,848.28
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	$3,848.28
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,961.87
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,263.70
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

OP TX HUMERS SHFT FX,PLT/SCRW

Facility

$63,943.60

Service Code	HCPCS 24515
Hospital Charge Code	1600000619
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OP TX HUMERS SHFT FX,PLT/SCRW

Facility

$63,943.60

Service Code	HCPCS 24515
Hospital Charge Code	1600000619
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$19,183.08
Rate for Payer: Aetna Medicare Advantage	$19,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,305.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,305.62
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	$16,305.62
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,312.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OP TX MANDIB FX W MULTI OPS&FI

Facility

$42,339.20

Service Code	HCPCS 21470
Hospital Charge Code	1600000854
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Medicare Advantage	$12,701.76
Rate for Payer: Aetna Commercial	$12,701.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,796.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,796.50
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	$10,796.50
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,504.10
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

OP TX MANDIB FX W MULTI OPS&FI

Facility

$42,339.20

Service Code	HCPCS 21470
Hospital Charge Code	1600000854
Hospital Revenue Code	360
Min. Negotiated Rate	$6,350.88
Max. Negotiated Rate	$6,350.88
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88

OP TX OF NASAL FX; W OP TX SEP

Facility

$12,277.44

Service Code	HCPCS 21335
Hospital Charge Code	1600000740
Hospital Revenue Code	360
Min. Negotiated Rate	$1,841.62
Max. Negotiated Rate	$1,841.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.62

OP TX OF NASAL FX; W OP TX SEP

Facility

$12,277.44

Service Code	HCPCS 21335
Hospital Charge Code	1600000740
Hospital Revenue Code	360
Min. Negotiated Rate	$1,596.07
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$3,683.23
Rate for Payer: Aetna Medicare Advantage	$3,683.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,130.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,130.75
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	$3,130.75
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,596.07
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.62
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

OP TX PATEL FX W IF &/REP

Facility

$12,280.69

Service Code	HCPCS 27524
Hospital Charge Code	16000425
Hospital Revenue Code	360
Min. Negotiated Rate	$1,596.49
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$3,684.21
Rate for Payer: Aetna Medicare Advantage	$3,684.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,131.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,131.58
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	$3,131.58
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,596.49
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,842.10
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges