Heights University Hospital

All Charges

Charge

Type

Setting

Price

PECA 4X42MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705983
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$1,076.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: Qualcare PPO/HMO/WC	$667.50

PECA 4X42MM

Facility

$4,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705983
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$2,225.00
Rate for Payer: Aetna Commercial	$1,335.00
Rate for Payer: Aetna Medicare Advantage	$1,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.75
Rate for Payer: Cigna Commercial	$2,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: Qualcare PPO/HMO/WC	$667.50

PECTIN/GEL ORAL OINT 5GM

Facility

$21.15

Hospital Charge Code	6004089
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

PECTIN/GEL ORAL OINT 5GM

Facility

$21.15

Hospital Charge Code	6004089
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,265.32
Max. Negotiated Rate	$1,265.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,096.61
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$2,530.64
Rate for Payer: Aetna Medicare Advantage	$2,530.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,151.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,151.05
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	$2,151.05
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,096.61
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$26.10
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

PEDIALYTE SOL .237ML

Facility

$17.95

Hospital Charge Code	6027155
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

PEDIALYTE SOL .237ML

Facility

$17.95

Hospital Charge Code	6027155
Hospital Revenue Code	251
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

PEDIAPRED/6.7MG/5ML

Facility

$21.00

Hospital Charge Code	60633617
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

PEDIAPRED/6.7MG/5ML

Facility

$21.00

Hospital Charge Code	60633617
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$108.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$223.68
Rate for Payer: Aetna Commercial	$134.21
Rate for Payer: Aetna Medicare Advantage	$134.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.08
Rate for Payer: Cigna Commercial	$223.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$84.54
Max. Negotiated Rate	$84.54
Rate for Payer: Qualcare PPO/HMO/WC	$84.54

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$73.27
Max. Negotiated Rate	$281.80
Rate for Payer: Aetna Commercial	$169.08
Rate for Payer: Aetna Medicare Advantage	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.72
Rate for Payer: Cigna Commercial	$281.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.27
Rate for Payer: Oxford Commercial	$281.80
Rate for Payer: Qualcare PPO/HMO/WC	$84.54
Rate for Payer: UnitedHealthcare Commercial	$281.80

PEDIASURE

Facility

$5.00

Hospital Charge Code	60634856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

PEDIASURE

Facility

$5.00

Hospital Charge Code	60634856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

PEDIATRIC NPSG < 6 Y/O

Facility

$5,700.00

Service Code	HCPCS 95782
Hospital Charge Code	90000002
Hospital Revenue Code	922
Min. Negotiated Rate	$704.74
Max. Negotiated Rate	$2,044.99
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$704.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

PEDIATRIC NPSG < 6 Y/O

Facility

$5,700.00

Service Code	HCPCS 95782
Hospital Charge Code	90000002
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

PEDIATRIC RESUSCITATION MED/IN

Facility

$1,050.00

Hospital Charge Code	270665159
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

PEDIATRIC RESUSCITATION MED/IN

Facility

$1,050.00

Hospital Charge Code	270665159
Hospital Revenue Code	270
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$525.00

PEDIAZOLE/100ML

Facility

$90.00

Hospital Charge Code	60633618
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

PEDIAZOLE/100ML

Facility

$90.00

Hospital Charge Code	60633618
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

PEDICLE FLAP,TRUNK

Facility

$16,902.88

Service Code	HCPCS 15570
Hospital Charge Code	16000598
Hospital Revenue Code	360
Min. Negotiated Rate	$2,535.43
Max. Negotiated Rate	$2,535.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.43

Know your out-of-pocket cost for care.

All Charges