Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$2,700.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,564.38
Max. Negotiated Rate	$5,750.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,564.38
Max. Negotiated Rate	$11,881.25
Rate for Payer: Aetna Commercial	$7,128.75
Rate for Payer: Aetna Medicare Advantage	$7,128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,059.44
Rate for Payer: Cigna Commercial	$11,881.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38

PHASIX ST MESH 25X30

Facility

$106,755.00

Hospital Charge Code	270703542
Hospital Revenue Code	278
Min. Negotiated Rate	$16,013.25
Max. Negotiated Rate	$25,834.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,834.71
Rate for Payer: Qualcare PPO/HMO/WC	$16,013.25

PHASIX ST MESH 25X30

Facility

$106,755.00

Hospital Charge Code	270703542
Hospital Revenue Code	278
Min. Negotiated Rate	$16,013.25
Max. Negotiated Rate	$53,377.50
Rate for Payer: Aetna Commercial	$32,026.50
Rate for Payer: Aetna Medicare Advantage	$32,026.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,222.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,222.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,222.53
Rate for Payer: Cigna Commercial	$53,377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,834.71
Rate for Payer: Qualcare PPO/HMO/WC	$16,013.25

PHASIX ST MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
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 MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
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 MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$2,208.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

PHASIX ST MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$2,737.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

PHAZYME/60MG/TAB

Facility

$1.00

Hospital Charge Code	60633648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

PHAZYME/60MG/TAB

Facility

$1.00

Hospital Charge Code	60633648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PHAZYME 95/95MG/TAB

Facility

$3.00

Hospital Charge Code	60633649
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

PHAZYME 95/95MG/TAB

Facility

$3.00

Hospital Charge Code	60633649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008647
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008646
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008646
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH BODY FLUID

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3008647
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges