Heights University Hospital

All Charges

Charge

Type

Setting

Price

PAD WITCH HAZEL (TUCKS)

Facility

$4.00

Hospital Charge Code	270301315
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PAI-1

Facility

$897.05

Service Code	HCPCS 85415
Hospital Charge Code	401048415
Hospital Revenue Code	301
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$134.56
Rate for Payer: Aetna Commercial	$55.70
Rate for Payer: Aetna Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$17.19
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.56
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.22
Rate for Payer: Wellcare Medicare Advantage	$17.19

PAI-1

Facility

$897.05

Service Code	HCPCS 85415
Hospital Charge Code	401048415
Hospital Revenue Code	301
Min. Negotiated Rate	$134.56
Max. Negotiated Rate	$134.56
Rate for Payer: Qualcare PPO/HMO/WC	$134.56

PAIN,MEPERIDINE,QN,U

Facility

$133.70

Service Code	HCPCS 80300
Hospital Charge Code	39900114
Hospital Revenue Code	301
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

PAIN,MEPERIDINE,QN,U

Facility

$133.70

Service Code	HCPCS 80300
Hospital Charge Code	39900114
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.11
Rate for Payer: Aetna Medicare Advantage	$40.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.09
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

PAJAMA ADULT

Facility

$11.25

Hospital Charge Code	270658720
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

PAJAMA ADULT

Facility

$11.25

Hospital Charge Code	270658720
Hospital Revenue Code	270
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

PAK INTREPID ULTRASLEEVE .9MM

Facility

$1,090.00

Hospital Charge Code	270670985
Hospital Revenue Code	272
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Qualcare PPO/HMO/WC	$163.50

PAK INTREPID ULTRASLEEVE .9MM

Facility

$1,090.00

Hospital Charge Code	270670985
Hospital Revenue Code	272
Min. Negotiated Rate	$141.70
Max. Negotiated Rate	$545.00
Rate for Payer: Aetna Commercial	$327.00
Rate for Payer: Aetna Medicare Advantage	$327.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$277.95
Rate for Payer: Cigna Commercial	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.70
Rate for Payer: Oxford Commercial	$545.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.50
Rate for Payer: UnitedHealthcare Commercial	$545.00

PALACO BONE CEMENT

Facility

$885.00

Hospital Charge Code	270657659
Hospital Revenue Code	278
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna Commercial	$265.50
Rate for Payer: Aetna Medicare Advantage	$265.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.68
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: Qualcare PPO/HMO/WC	$132.75

PALACO BONE CEMENT

Facility

$885.00

Hospital Charge Code	270657659
Hospital Revenue Code	278
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$214.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: Qualcare PPO/HMO/WC	$132.75

PALACO R 1CX40 CEMENT

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	270635157
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.01
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

PALACO R 1CX40 CEMENT

Facility

$405.00

Service Code	HCPCS C1713
Hospital Charge Code	270635157
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$98.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.01
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

PALACOS R+G 1X40 SINGLE (W GEN

Facility

$2,000.05

Hospital Charge Code	270657051
Hospital Revenue Code	278
Min. Negotiated Rate	$300.01
Max. Negotiated Rate	$1,000.02
Rate for Payer: Aetna Commercial	$600.01
Rate for Payer: Aetna Medicare Advantage	$600.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.01
Rate for Payer: Cigna Commercial	$1,000.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01

PALACOS R+G 1X40 SINGLE (W GEN

Facility

$2,000.05

Hospital Charge Code	270657051
Hospital Revenue Code	278
Min. Negotiated Rate	$300.01
Max. Negotiated Rate	$484.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.01
Rate for Payer: Qualcare PPO/HMO/WC	$300.01

PALACOS R+G 1X40 SINGLE WITH G

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270657049
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PALACOS R+G 1X40 SINGLE WITH G

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270657049
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PALACOS R+G SINGLE 1 X 40

Facility

$2,000.00

Hospital Charge Code	270658749
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PALACOS R+G SINGLE 1 X 40

Facility

$2,000.00

Hospital Charge Code	270658749
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PALIPERIDONE 1.5MG ER TABLETS

Facility

$204.48

Service Code	NDC 10147095103
Hospital Charge Code	606390238
Hospital Revenue Code	250
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$30.67
Rate for Payer: Qualcare PPO/HMO/WC	$30.67

PALIPERIDONE 1.5MG ER TABLETS

Facility

$204.48

Service Code	NDC 10147095103
Hospital Charge Code	606390238
Hospital Revenue Code	250
Min. Negotiated Rate	$26.58
Max. Negotiated Rate	$102.24
Rate for Payer: Aetna Commercial	$61.34
Rate for Payer: Aetna Medicare Advantage	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.14
Rate for Payer: Cigna Commercial	$102.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.58
Rate for Payer: Oxford Commercial	$102.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.67
Rate for Payer: UnitedHealthcare Commercial	$102.24

PALIPERIDONE 3MG TAB

Facility

$154.70

Service Code	NDC 35356045030
Hospital Charge Code	6063943156
Hospital Revenue Code	250
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

PALIPERIDONE 3MG TAB

Facility

$154.70

Service Code	NDC 35356045030
Hospital Charge Code	6063943156
Hospital Revenue Code	250
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.11
Rate for Payer: Oxford Commercial	$77.35
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Commercial	$77.35

PALIPERIDONE 6MG TAB

Facility

$323.74

Service Code	NDC 50458055101
Hospital Charge Code	6063943157
Hospital Revenue Code	250
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$48.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.56

PALIPERIDONE 6MG TAB

Facility

$323.74

Service Code	NDC 50458055101
Hospital Charge Code	6063943157
Hospital Revenue Code	250
Min. Negotiated Rate	$42.09
Max. Negotiated Rate	$161.87
Rate for Payer: Aetna Commercial	$97.12
Rate for Payer: Aetna Medicare Advantage	$97.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.55
Rate for Payer: Cigna Commercial	$161.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.09
Rate for Payer: Oxford Commercial	$161.87
Rate for Payer: Qualcare PPO/HMO/WC	$48.56
Rate for Payer: UnitedHealthcare Commercial	$161.87

Know your out-of-pocket cost for care.

All Charges