Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHYSOSTIGMN SULF OINT OPH3.5GM

Facility

$19.85

Hospital Charge Code	6004329
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$31.79
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.35
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.79
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$7.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$9.31
Rate for Payer: Aetna Commercial	$9.31
Rate for Payer: Aetna Medicare Advantage	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$3.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PHYTONADIONE 1MG/.5ML AMP

Facility

$12.00

Hospital Charge Code	60635791
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

PHYTONADIONE 1MG/.5ML AMP

Facility

$12.00

Hospital Charge Code	60635791
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.93

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna Commercial	$31.86
Rate for Payer: Aetna Medicare Advantage	$31.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.08
Rate for Payer: Cigna Commercial	$53.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: Oxford Commercial	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$15.93
Rate for Payer: UnitedHealthcare Commercial	$53.10

PHYTONADIONE INJ 10MG/ML

Facility

$31.15

Hospital Charge Code	6004337A
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.67

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$27.64
Rate for Payer: Aetna Medicare Advantage	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.49
Rate for Payer: Cigna Commercial	$3.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$22.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82

PHYTONADIONE INJ 10MG/ML

Facility

$31.15

Hospital Charge Code	6004337A
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$15.57
Rate for Payer: Aetna Commercial	$9.35
Rate for Payer: Aetna Medicare Advantage	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.94
Rate for Payer: Cigna Commercial	$15.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.05
Rate for Payer: Oxford Commercial	$15.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.67
Rate for Payer: UnitedHealthcare Commercial	$15.57

PHYTONADIONE INJ 2MG/ML

Facility

$53.20

Hospital Charge Code	60628494
Hospital Revenue Code	250
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$15.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.57
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.92
Rate for Payer: Oxford Commercial	$26.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.98
Rate for Payer: UnitedHealthcare Commercial	$26.60

PHYTONADIONE INJ 2MG/ML

Facility

$53.20

Hospital Charge Code	60628494
Hospital Revenue Code	250
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$7.98
Rate for Payer: Qualcare PPO/HMO/WC	$7.98

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$59.59
Max. Negotiated Rate	$59.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.59

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$51.65
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$119.19
Rate for Payer: Aetna Medicare Advantage	$119.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.31
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	$101.31
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.65
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.59
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$976.50
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$976.50
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$2,355.72
Rate for Payer: Aetna Medicare Advantage	$2,355.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,002.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,002.36
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	$2,002.36
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.81
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,177.86
Max. Negotiated Rate	$1,177.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86

PICC LINE4FR LUMEN W/70CM WIRE

Facility

$760.50

Hospital Charge Code	2709007029
Hospital Revenue Code	272
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

PICC LINE4FR LUMEN W/70CM WIRE

Facility

$760.50

Hospital Charge Code	2709007029
Hospital Revenue Code	272
Min. Negotiated Rate	$98.86
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$228.15
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.86
Rate for Payer: Oxford Commercial	$380.25
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$380.25

Know your out-of-pocket cost for care.

All Charges