Heights University Hospital

All Charges

Charge

Type

Setting

Price

O-RING PART 1102-3043-000

Facility

$45.75

Hospital Charge Code	270660189
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$13.72
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Oxford Commercial	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$22.88

O-RING PART 1102-3043-000

Facility

$45.75

Hospital Charge Code	270660189
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

O'RING PREVI COLOR NOZZLE

Facility

$10.75

Hospital Charge Code	270666255
Hospital Revenue Code	270
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

O'RING PREVI COLOR NOZZLE

Facility

$10.75

Hospital Charge Code	270666255
Hospital Revenue Code	270
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.38
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna Medicare Advantage	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.74
Rate for Payer: Cigna Commercial	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$5.38

OR INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	1600510
Hospital Revenue Code	260
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

OR INJECTION INTRA-ARTERIAL

Facility

$250.00

Service Code	HCPCS 96373
Hospital Charge Code	1600510
Hospital Revenue Code	260
Min. Negotiated Rate	$12.12
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$802.00

ORIOS XT 10CC

Facility

$18,550.00

Service Code	HCPCS C1765
Hospital Charge Code	270704862
Hospital Revenue Code	278
Min. Negotiated Rate	$2,782.50
Max. Negotiated Rate	$9,275.00
Rate for Payer: Aetna Commercial	$5,565.00
Rate for Payer: Aetna Medicare Advantage	$5,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,730.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,730.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,730.25
Rate for Payer: Cigna Commercial	$9,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,489.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,782.50

ORIOS XT 10CC

Facility

$18,550.00

Service Code	HCPCS C1765
Hospital Charge Code	270704862
Hospital Revenue Code	278
Min. Negotiated Rate	$2,782.50
Max. Negotiated Rate	$4,489.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,489.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,782.50

ORIOS XT 5CC

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270704165
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,320.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

ORIOS XT 5CC

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270704165
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,064.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$212.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$212.50

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

OR MAJOR 1 HOUR

Facility

$3,597.56

Hospital Charge Code	1600014
Hospital Revenue Code	360
Min. Negotiated Rate	$539.63
Max. Negotiated Rate	$539.63
Rate for Payer: Qualcare PPO/HMO/WC	$539.63

OR MAJOR 1 HOUR

Facility

$3,597.56

Hospital Charge Code	1600014
Hospital Revenue Code	360
Min. Negotiated Rate	$467.68
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,079.27
Rate for Payer: Aetna Medicare Advantage	$1,079.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$917.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$917.38
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	$917.38
Rate for Payer: Cigna Commercial	$1,798.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.68
Rate for Payer: Qualcare PPO/HMO/WC	$539.63

*****OR MAJOR 2 TO 3 HOURS

Facility

$2,204.00

Hospital Charge Code	1600030
Hospital Revenue Code	360
Min. Negotiated Rate	$286.52
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$661.20
Rate for Payer: Aetna Medicare Advantage	$661.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.02
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	$562.02
Rate for Payer: Cigna Commercial	$1,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.52
Rate for Payer: Qualcare PPO/HMO/WC	$330.60

*****OR MAJOR 2 TO 3 HOURS

Facility

$2,204.00

Hospital Charge Code	1600030
Hospital Revenue Code	360
Min. Negotiated Rate	$330.60
Max. Negotiated Rate	$330.60
Rate for Payer: Qualcare PPO/HMO/WC	$330.60

*****OR MAJOR 3 TO 4 HOURS

Facility

$2,868.00

Hospital Charge Code	1600048
Hospital Revenue Code	360
Min. Negotiated Rate	$372.84
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$860.40
Rate for Payer: Aetna Medicare Advantage	$860.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$731.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$731.34
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	$731.34
Rate for Payer: Cigna Commercial	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.84
Rate for Payer: Qualcare PPO/HMO/WC	$430.20

*****OR MAJOR 3 TO 4 HOURS

Facility

$2,868.00

Hospital Charge Code	1600048
Hospital Revenue Code	360
Min. Negotiated Rate	$430.20
Max. Negotiated Rate	$430.20
Rate for Payer: Qualcare PPO/HMO/WC	$430.20

*****OR MAJOR 5 TO 6 HOURS

Facility

$6,024.00

Hospital Charge Code	1600063
Hospital Revenue Code	360
Min. Negotiated Rate	$783.12
Max. Negotiated Rate	$3,012.00
Rate for Payer: Aetna Commercial	$1,807.20
Rate for Payer: Aetna Medicare Advantage	$1,807.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,536.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,536.12
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	$1,536.12
Rate for Payer: Cigna Commercial	$3,012.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.12
Rate for Payer: Qualcare PPO/HMO/WC	$903.60

*****OR MAJOR 5 TO 6 HOURS

Facility

$6,024.00

Hospital Charge Code	1600063
Hospital Revenue Code	360
Min. Negotiated Rate	$903.60
Max. Negotiated Rate	$903.60
Rate for Payer: Qualcare PPO/HMO/WC	$903.60

*****OR MAJOR 6 TO 7 HOURS

Facility

$6,303.00

Hospital Charge Code	1600071
Hospital Revenue Code	361
Min. Negotiated Rate	$819.39
Max. Negotiated Rate	$3,151.50
Rate for Payer: Aetna Commercial	$1,890.90
Rate for Payer: Aetna Medicare Advantage	$1,890.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,607.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,607.27
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	$1,607.27
Rate for Payer: Cigna Commercial	$3,151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$819.39
Rate for Payer: Qualcare PPO/HMO/WC	$945.45

*****OR MAJOR 6 TO 7 HOURS

Facility

$6,303.00

Hospital Charge Code	1600071
Hospital Revenue Code	361
Min. Negotiated Rate	$945.45
Max. Negotiated Rate	$945.45
Rate for Payer: Qualcare PPO/HMO/WC	$945.45

*****OR MAJOR 7 TO 8 HOURS

Facility

$7,129.00

Hospital Charge Code	1600089
Hospital Revenue Code	361
Min. Negotiated Rate	$926.77
Max. Negotiated Rate	$3,564.50
Rate for Payer: Aetna Commercial	$2,138.70
Rate for Payer: Aetna Medicare Advantage	$2,138.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,817.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,817.89
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	$1,817.89
Rate for Payer: Cigna Commercial	$3,564.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,069.35

*****OR MAJOR 7 TO 8 HOURS

Facility

$7,129.00

Hospital Charge Code	1600089
Hospital Revenue Code	361
Min. Negotiated Rate	$1,069.35
Max. Negotiated Rate	$1,069.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,069.35

OR MAJOR EACH ADD'L HOUR

Facility

$2,211.34

Hospital Charge Code	1600097
Hospital Revenue Code	360
Min. Negotiated Rate	$287.47
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$663.40
Rate for Payer: Aetna Medicare Advantage	$663.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.89
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	$563.89
Rate for Payer: Cigna Commercial	$1,105.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.47
Rate for Payer: Qualcare PPO/HMO/WC	$331.70

Know your out-of-pocket cost for care.

All Charges