Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

PESSARY****

Facility

$30.00

Hospital Charge Code	1810035
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

PESSARY****

Facility

$30.00

Hospital Charge Code	1810035
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

PESSARY HODGE SILICONE 2

Facility

$281.65

Hospital Charge Code	270610500
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 2

Facility

$281.65

Hospital Charge Code	270610500
Hospital Revenue Code	272
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

PESSARY HODGE SILICONE 3

Facility

$281.65

Hospital Charge Code	270610499
Hospital Revenue Code	272
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

PESSARY HODGE SILICONE 3

Facility

$281.65

Hospital Charge Code	270610499
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 4

Facility

$281.65

Hospital Charge Code	270610501
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PESSARY HODGE SILICONE 4

Facility

$281.65

Hospital Charge Code	270610501
Hospital Revenue Code	272
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

PESSARY HODGE SILICONE 6

Facility

$281.65

Hospital Charge Code	270610497
Hospital Revenue Code	272
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$140.82
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$140.82

PESSARY HODGE SILICONE 6

Facility

$281.65

Hospital Charge Code	270610497
Hospital Revenue Code	272
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	4501024
Hospital Revenue Code	404
Min. Negotiated Rate	$1,784.15
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$4,117.27
Rate for Payer: Aetna Medicare Advantage	$4,117.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,499.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,499.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,499.68
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.15
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	80000050
Hospital Revenue Code	404
Min. Negotiated Rate	$1,784.15
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Medicare Advantage	$4,117.27
Rate for Payer: Aetna Commercial	$4,117.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,499.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,499.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,499.68
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.15
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	4501024
Hospital Revenue Code	404
Min. Negotiated Rate	$2,058.64
Max. Negotiated Rate	$2,058.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64

PET BRAIN IMAGING METAB EVAL

Facility

$13,724.25

Service Code	HCPCS 78608
Hospital Charge Code	80000050
Hospital Revenue Code	404
Min. Negotiated Rate	$2,058.64
Max. Negotiated Rate	$2,058.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64

PET BRAIN IMAG METAB EVAL - PI

Facility

$40,000.00

Service Code	HCPCS 78608PI
Hospital Charge Code	80000050PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET BRAIN IMAG METAB EVAL - PI

Facility

$40,000.00

Service Code	HCPCS 78608PI
Hospital Charge Code	80000050PI
Hospital Revenue Code	404
Min. Negotiated Rate	$5,200.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET BRAIN IMAG METAB EVAL- PS

Facility

$40,000.00

Service Code	HCPCS 78608PS
Hospital Charge Code	80000050PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET BRAIN IMAG METAB EVAL- PS

Facility

$40,000.00

Service Code	HCPCS 78608PS
Hospital Charge Code	80000050PS
Hospital Revenue Code	404
Min. Negotiated Rate	$5,200.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET BS TO THIGH CA INIT

Facility

$21,817.37

Service Code	HCPCS 78815PI
Hospital Charge Code	4501026PI
Hospital Revenue Code	404
Min. Negotiated Rate	$3,272.61
Max. Negotiated Rate	$3,272.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61

PET BS TO THIGH CA INIT

Facility

$21,817.37

Service Code	HCPCS 78815PI
Hospital Charge Code	4501026PI
Hospital Revenue Code	404
Min. Negotiated Rate	$2,836.26
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$6,545.21
Rate for Payer: Aetna Medicare Advantage	$6,545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,563.43
Rate for Payer: Cigna Commercial	$10,908.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.26
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET BS TO THIGH CA SUBS

Facility

$21,817.37

Service Code	HCPCS 78815PS
Hospital Charge Code	4501026PS
Hospital Revenue Code	404
Min. Negotiated Rate	$3,272.61
Max. Negotiated Rate	$3,272.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61

PET BS TO THIGH CA SUBS

Facility

$21,817.37

Service Code	HCPCS 78815PS
Hospital Charge Code	4501026PS
Hospital Revenue Code	404
Min. Negotiated Rate	$2,836.26
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$6,545.21
Rate for Payer: Aetna Medicare Advantage	$6,545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,563.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,563.43
Rate for Payer: Cigna Commercial	$10,908.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.26
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,272.61
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD

Facility

$1,556.65

Service Code	HCPCS 78814
Hospital Charge Code	85000885
Hospital Revenue Code	404
Min. Negotiated Rate	$233.50
Max. Negotiated Rate	$233.50
Rate for Payer: Qualcare PPO/HMO/WC	$233.50

PET IMAGE W/CT LMTD

Facility

$1,556.65

Service Code	HCPCS 78814
Hospital Charge Code	85000885
Hospital Revenue Code	404
Min. Negotiated Rate	$202.36
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$467.00
Rate for Payer: Aetna Medicare Advantage	$467.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$396.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$396.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$396.95
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.36
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$233.50
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

Know your out-of-pocket cost for care.

All Charges