Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERSANTINE/75MG/BULK

Facility

$3.00

Hospital Charge Code	60634633
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/75MG/BULK

Facility

$3.00

Hospital Charge Code	60634633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE/75MG/TAB

Facility

$3.00

Hospital Charge Code	60633641
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/75MG/TAB

Facility

$3.00

Hospital Charge Code	60633641
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERSANTINE IV 10ML

Facility

$1,000.00

Hospital Charge Code	60635021
Hospital Revenue Code	250
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

PERSANTINE IV 10ML

Facility

$1,000.00

Hospital Charge Code	60635021
Hospital Revenue Code	250
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

PERSANTINE IV/5MG/1ML

Facility

$6.00

Hospital Charge Code	60634347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PERSANTINE IV/5MG/1ML

Facility

$6.00

Hospital Charge Code	60634347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

PERSONA EXT TAPERD CEM 14X30MM

Facility

$6,042.00

Service Code	HCPCS C1776
Hospital Charge Code	270686934
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$1,812.60
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PERSONA EXT TAPERD CEM 14X30MM

Facility

$6,042.00

Service Code	HCPCS C1776
Hospital Charge Code	270686934
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PERSONA LEFT ARTICULAR SURFACE

Facility

$13,181.25

Service Code	HCPCS C1776
Hospital Charge Code	270703896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.19
Max. Negotiated Rate	$6,590.62
Rate for Payer: Aetna Commercial	$3,954.38
Rate for Payer: Aetna Medicare Advantage	$3,954.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.22
Rate for Payer: Cigna Commercial	$6,590.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.19

PERSONA LEFT ARTICULAR SURFACE

Facility

$13,181.25

Service Code	HCPCS C1776
Hospital Charge Code	270703896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.19
Max. Negotiated Rate	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.19

PERSONALITY DISORDERS

Facility

$13,614.10

Service Code	APR-DRG 7523
Min. Negotiated Rate	$7,603.78
Max. Negotiated Rate	$13,614.10
Rate for Payer: Aetna Better Health Medicaid	$13,347.16
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,614.10
Rate for Payer: Wellpoint Medicaid Managed Care	$7,603.78

PERSONALITY DISORDERS

Facility

$3,862.05

Service Code	APR-DRG 7521
Min. Negotiated Rate	$3,035.50
Max. Negotiated Rate	$3,862.05
Rate for Payer: Aetna Better Health Medicaid	$3,786.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$3,862.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3,035.50

PERSONALITY DISORDERS

Facility

$5,475.72

Service Code	APR-DRG 7522
Min. Negotiated Rate	$4,309.53
Max. Negotiated Rate	$5,475.72
Rate for Payer: Aetna Better Health Medicaid	$5,368.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,475.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4,309.53

PERSONALITY DISORDERS

Facility

$49,685.63

Service Code	APR-DRG 7524
Min. Negotiated Rate	$8,158.79
Max. Negotiated Rate	$49,685.63
Rate for Payer: Aetna Better Health Medicaid	$48,711.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49,685.63
Rate for Payer: Wellpoint Medicaid Managed Care	$8,158.79

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	4512631
Hospital Revenue Code	911
Min. Negotiated Rate	$533.52
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna Commercial	$1,231.20
Rate for Payer: Aetna Medicare Advantage	$1,231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.52
Rate for Payer: Cigna Commercial	$2,052.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.52
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	4512631
Hospital Revenue Code	911
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$615.60
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	7500131
Hospital Revenue Code	911
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$615.60
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

PERS ONSITE <24 HRS

Facility

$4,104.00

Service Code	HCPCS S9480
Hospital Charge Code	7500131
Hospital Revenue Code	911
Min. Negotiated Rate	$533.52
Max. Negotiated Rate	$2,052.00
Rate for Payer: Aetna Commercial	$1,231.20
Rate for Payer: Aetna Medicare Advantage	$1,231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.52
Rate for Payer: Cigna Commercial	$2,052.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.52
Rate for Payer: Qualcare PPO/HMO/WC	$615.60

PERS ONSITE EA ADD HR >24

Facility

$136.15

Hospital Charge Code	7500132
Hospital Revenue Code	911
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$68.08
Rate for Payer: Aetna Commercial	$40.84
Rate for Payer: Aetna Medicare Advantage	$40.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.72
Rate for Payer: Cigna Commercial	$68.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.42

PERS ONSITE EA ADD HR >24

Facility

$136.15

Hospital Charge Code	7500132
Hospital Revenue Code	911
Min. Negotiated Rate	$20.42
Max. Negotiated Rate	$20.42
Rate for Payer: Qualcare PPO/HMO/WC	$20.42

PERTECHNETATE FLOOD

Facility

$22.15

Hospital Charge Code	270658211
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

PERTECHNETATE FLOOD

Facility

$22.15

Hospital Charge Code	270658211
Hospital Revenue Code	270
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$11.07
Rate for Payer: Aetna Commercial	$6.64
Rate for Payer: Aetna Medicare Advantage	$6.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.65
Rate for Payer: Cigna Commercial	$11.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.88
Rate for Payer: Oxford Commercial	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$11.07

PERTUZUMAB PER 10MG INJ

Facility

$510.45

Hospital Charge Code	60639600
Hospital Revenue Code	636
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$123.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$76.57

Know your out-of-pocket cost for care.

All Charges