Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PHARMACOLOGIC MANAGEMENT

Facility

$474.90

Service Code	HCPCS 90862
Hospital Charge Code	9310120
Hospital Revenue Code	914
Min. Negotiated Rate	$61.74
Max. Negotiated Rate	$237.45
Rate for Payer: Aetna Commercial	$142.47
Rate for Payer: Aetna Medicare Advantage	$142.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.10
Rate for Payer: Cigna Commercial	$237.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.74
Rate for Payer: Qualcare PPO/HMO/WC	$71.23

PHARMACOLOGIC MANAGEMENT

Facility

$474.90

Service Code	HCPCS 90862
Hospital Charge Code	9310120
Hospital Revenue Code	914
Min. Negotiated Rate	$71.23
Max. Negotiated Rate	$71.23
Rate for Payer: Qualcare PPO/HMO/WC	$71.23

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$5,625.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	270695944
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$11,625.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	27069544
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$11,625.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	27069544
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$24,018.75
Rate for Payer: Aetna Commercial	$14,411.25
Rate for Payer: Aetna Medicare Advantage	$14,411.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,249.56
Rate for Payer: Cigna Commercial	$24,018.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH 8X10in

Facility

$48,037.50

Hospital Charge Code	270695944
Hospital Revenue Code	278
Min. Negotiated Rate	$7,205.62
Max. Negotiated Rate	$24,018.75
Rate for Payer: Aetna Commercial	$14,411.25
Rate for Payer: Aetna Medicare Advantage	$14,411.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,249.56
Rate for Payer: Cigna Commercial	$24,018.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,625.08
Rate for Payer: Qualcare PPO/HMO/WC	$7,205.62

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$885.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$862.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$423.75
Max. Negotiated Rate	$683.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: Qualcare PPO/HMO/WC	$423.75

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$423.75
Max. Negotiated Rate	$1,412.50
Rate for Payer: Cigna Commercial	$1,412.50
Rate for Payer: Aetna Commercial	$847.50
Rate for Payer: Aetna Medicare Advantage	$847.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$720.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: Qualcare PPO/HMO/WC	$423.75

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$2,820.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,274.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$7,045.17
Max. Negotiated Rate	$23,483.90
Rate for Payer: Aetna Commercial	$14,090.34
Rate for Payer: Aetna Medicare Advantage	$14,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,976.79
Rate for Payer: Cigna Commercial	$23,483.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$7,045.17
Max. Negotiated Rate	$11,366.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17

PHASIX ST MESH

Facility

$35,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270686889
Hospital Revenue Code	278
Min. Negotiated Rate	$5,317.50
Max. Negotiated Rate	$8,578.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,578.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,317.50

Know your out-of-pocket cost for care.

All Charges