Heights University Hospital

All Charges

Charge

Type

Setting

Price

PITOCIN 10U IN LR 1L

Facility

$9,031.60

Service Code	NDC 61553076904
Hospital Charge Code	60635522
Hospital Revenue Code	250
Min. Negotiated Rate	$1,354.74
Max. Negotiated Rate	$1,354.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.74

PITOCIN 10 UNITS****

Facility

$31.00

Service Code	HCPCS J2590
Hospital Charge Code	6008189
Hospital Revenue Code	259
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
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	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$15.50

PITOCIN 10 UNITS****

Facility

$31.00

Service Code	HCPCS J2590
Hospital Charge Code	6008189
Hospital Revenue Code	259
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$18.43

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$1,002.55
Rate for Payer: Aetna Commercial	$601.53
Rate for Payer: Aetna Medicare Advantage	$601.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.30
Rate for Payer: Cigna Commercial	$1,002.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: Qualcare PPO/HMO/WC	$300.76

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$485.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: Qualcare PPO/HMO/WC	$300.76

PK CUSTOM LAP CHOLE SLC11LPBYC

Facility

$283.25

Hospital Charge Code	270632135
Hospital Revenue Code	272
Min. Negotiated Rate	$36.82
Max. Negotiated Rate	$141.62
Rate for Payer: Aetna Commercial	$84.97
Rate for Payer: Aetna Medicare Advantage	$84.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.23
Rate for Payer: Cigna Commercial	$141.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.82
Rate for Payer: Oxford Commercial	$141.62
Rate for Payer: Qualcare PPO/HMO/WC	$42.49
Rate for Payer: UnitedHealthcare Commercial	$141.62

PK CUSTOM LAP CHOLE SLC11LPBYC

Facility

$283.25

Hospital Charge Code	270632135
Hospital Revenue Code	272
Min. Negotiated Rate	$42.49
Max. Negotiated Rate	$42.49
Rate for Payer: Qualcare PPO/HMO/WC	$42.49

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$42.77
Max. Negotiated Rate	$164.50
Rate for Payer: Aetna Commercial	$98.70
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$164.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$164.50

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

PK INTRUMENT CORD G400 GENERAT

Facility

$1,350.00

Hospital Charge Code	270664008
Hospital Revenue Code	270
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$675.00

PK INTRUMENT CORD G400 GENERAT

Facility

$1,350.00

Hospital Charge Code	270664008
Hospital Revenue Code	270
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

PK INTRUMENT CORD PK AND SO GE

Facility

$1,350.00

Hospital Charge Code	270664909
Hospital Revenue Code	270
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$675.00

PK INTRUMENT CORD PK AND SO GE

Facility

$1,350.00

Hospital Charge Code	270664909
Hospital Revenue Code	270
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$6,450.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

PKU CARD

Facility

$139.25

Hospital Charge Code	1810027
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

PKU CARD

Facility

$139.25

Hospital Charge Code	1810027
Hospital Revenue Code	272
Min. Negotiated Rate	$18.10
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$41.77
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.10
Rate for Payer: Oxford Commercial	$69.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$69.62

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.15
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.83
Rate for Payer: Wellcare Medicare Advantage	$5.50

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83091020
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PKU TESTING

Facility

$153.00

Service Code	HCPCS 84030
Hospital Charge Code	38472544
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.15
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.83
Rate for Payer: Wellcare Medicare Advantage	$5.50

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83091020
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Aetna Commercial	$17.82
Rate for Payer: Aetna Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.15
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.83
Rate for Payer: Wellcare Medicare Advantage	$5.50

PKU TESTING

Facility

$153.00

Service Code	HCPCS 84030
Hospital Charge Code	38472544
Hospital Revenue Code	301
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

Know your out-of-pocket cost for care.

All Charges