Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22514
Hospital Charge Code	366822514
Hospital Revenue Code	320
Min. Negotiated Rate	$5,630.17
Max. Negotiated Rate	$5,630.17
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22514
Hospital Charge Code	366822514
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$11,260.34
Rate for Payer: Aetna Medicare Advantage	$11,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,015.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,571.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,879.48
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	7411355
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$11,260.34
Rate for Payer: Aetna Medicare Advantage	$11,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,571.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,879.48
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22514
Hospital Charge Code	7411356
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$11,260.34
Rate for Payer: Aetna Medicare Advantage	$11,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,015.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,571.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,879.48
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	7411355
Hospital Revenue Code	320
Min. Negotiated Rate	$5,630.17
Max. Negotiated Rate	$5,630.17
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	5701106
Hospital Revenue Code	360
Min. Negotiated Rate	$5,630.17
Max. Negotiated Rate	$5,630.17
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	5701106
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$11,260.34
Rate for Payer: Aetna Medicare Advantage	$11,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,571.29
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	$9,571.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,879.48
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PERQ VERTEBRAL AUGMENTATION

Facility

$15,443.85

Service Code	HCPCS 22515
Hospital Charge Code	411022515
Hospital Revenue Code	320
Min. Negotiated Rate	$2,316.58
Max. Negotiated Rate	$2,316.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,316.58

PERQ VERTEBRAL AUGMENTATION

Facility

$15,443.85

Service Code	HCPCS 22515
Hospital Charge Code	7411357
Hospital Revenue Code	320
Min. Negotiated Rate	$2,316.58
Max. Negotiated Rate	$2,316.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,316.58

PERQ VERTEBRAL AUGMENTATION

Facility

$15,443.85

Service Code	HCPCS 22515
Hospital Charge Code	321022515
Hospital Revenue Code	320
Min. Negotiated Rate	$2,316.58
Max. Negotiated Rate	$2,316.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,316.58

PERQ VERTEBRAL AUGMENTATION

Facility

$33,638.52

Service Code	HCPCS 22514
Hospital Charge Code	1600000450
Hospital Revenue Code	360
Min. Negotiated Rate	$5,045.78
Max. Negotiated Rate	$5,045.78
Rate for Payer: Qualcare PPO/HMO/WC	$5,045.78

PERQ VERTEBRAL AUGMENTATION

Facility

$15,443.85

Service Code	HCPCS 22515
Hospital Charge Code	366822515
Hospital Revenue Code	320
Min. Negotiated Rate	$204.23
Max. Negotiated Rate	$4,633.15
Rate for Payer: Aetna Commercial	$4,633.15
Rate for Payer: Aetna Medicare Advantage	$4,633.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,938.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,938.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,046.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,938.18
Rate for Payer: Cigna Commercial	$204.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,007.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,316.58
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	411022513
Hospital Revenue Code	320
Min. Negotiated Rate	$5,630.17
Max. Negotiated Rate	$5,630.17
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17

PERQ VERTEBRAL AUGMENTATION

Facility

$37,534.48

Service Code	HCPCS 22513
Hospital Charge Code	411022513
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$11,260.34
Rate for Payer: Aetna Medicare Advantage	$11,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,571.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,571.29
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,879.48
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,630.17
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERQ VERTEBRAL AUGMENTATION

Facility

$15,443.85

Service Code	HCPCS 22515
Hospital Charge Code	366822515
Hospital Revenue Code	320
Min. Negotiated Rate	$2,316.58
Max. Negotiated Rate	$2,316.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,316.58

PERQ VERTERBRAL AUGMENTATION

Facility

$33,092.48

Service Code	HCPCS 22513
Hospital Charge Code	16000605
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$9,927.74
Rate for Payer: Aetna Medicare Advantage	$9,927.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,438.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,438.58
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	$8,438.58
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.02
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,963.87
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PERQ VERTERBRAL AUGMENTATION

Facility

$33,092.48

Service Code	HCPCS 22513
Hospital Charge Code	16000605
Hospital Revenue Code	360
Min. Negotiated Rate	$4,963.87
Max. Negotiated Rate	$4,963.87
Rate for Payer: Qualcare PPO/HMO/WC	$4,963.87

PERSANTINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERSANTINE/25MG/TAB/BULK

Facility

$3.00

Hospital Charge Code	60634662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/25MG/TAB/BULK

Facility

$3.00

Hospital Charge Code	60634662
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERSANTINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PERSANTINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERSANTINE/50MG/TAB

Facility

$4.00

Hospital Charge Code	60633640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

Know your out-of-pocket cost for care.

All Charges