Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLASMAX 800-0515

Facility

$4,005.00

Hospital Charge Code	270637573
Hospital Revenue Code	272
Min. Negotiated Rate	$600.75
Max. Negotiated Rate	$600.75
Rate for Payer: Qualcare PPO/HMO/WC	$600.75

PLASMAX 800-0517

Facility

$4,505.00

Service Code	HCPCS C1713
Hospital Charge Code	270640107
Hospital Revenue Code	272
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$2,252.50
Rate for Payer: Aetna Commercial	$1,351.50
Rate for Payer: Aetna Medicare Advantage	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,148.78
Rate for Payer: Cigna Commercial	$2,252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.65
Rate for Payer: Oxford Commercial	$2,252.50
Rate for Payer: Qualcare PPO/HMO/WC	$675.75
Rate for Payer: UnitedHealthcare Commercial	$2,252.50

PLASMAX 800-0517

Facility

$4,505.00

Service Code	HCPCS C1713
Hospital Charge Code	270640107
Hospital Revenue Code	272
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$675.75
Rate for Payer: Qualcare PPO/HMO/WC	$675.75

PLASMINOGEN ACTIVATOR INH

Facility

$390.00

Service Code	HCPCS 85415
Hospital Charge Code	39900173
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLASMINOGEN ACTIVATOR INH

Facility

$390.00

Service Code	HCPCS 85415
Hospital Charge Code	39900173
Hospital Revenue Code	305
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.70
Rate for Payer: Aetna Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$17.19
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
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	$17.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.22
Rate for Payer: Wellcare Medicare Advantage	$17.19

PLASMINOGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	39900352
Hospital Revenue Code	305
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$6.53
Rate for Payer: Cigna Medicare Advantage	$3.27
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
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	$6.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.92
Rate for Payer: Wellcare Medicare Advantage	$6.53

PLASMINOGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	39900352
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLASMINOGEN AG ( PLASMA)

Facility

$50.90

Service Code	HCPCS 85421
Hospital Charge Code	401185421
Hospital Revenue Code	306
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.98
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.30
Rate for Payer: Cigna Commercial	$10.18
Rate for Payer: Cigna Medicare Advantage	$5.09
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.63
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.79
Rate for Payer: Wellcare Medicare Advantage	$10.18

PLASMINOGEN AG ( PLASMA)

Facility

$50.90

Service Code	HCPCS 85421
Hospital Charge Code	401185421
Hospital Revenue Code	306
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$7.63
Rate for Payer: Qualcare PPO/HMO/WC	$7.63

PLASMINOGEN (FUNCTIONAL)

Facility

$91.25

Service Code	HCPCS 85420
Hospital Charge Code	3008455
Hospital Revenue Code	305
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$6.53
Rate for Payer: Cigna Medicare Advantage	$3.27
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.92
Rate for Payer: Wellcare Medicare Advantage	$6.53

PLASMINOGEN (FUNCTIONAL)

Facility

$91.25

Service Code	HCPCS 85420
Hospital Charge Code	3008455
Hospital Revenue Code	305
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PLASMINOGEN,FUNCTIONAL

Facility

$48.00

Service Code	HCPCS 85420
Hospital Charge Code	38473151
Hospital Revenue Code	305
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$6.53
Rate for Payer: Cigna Medicare Advantage	$3.27
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.92
Rate for Payer: Wellcare Medicare Advantage	$6.53

PLASMINOGEN,FUNCTIONAL

Facility

$44.90

Service Code	HCPCS 85420
Hospital Charge Code	39900174
Hospital Revenue Code	305
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.74

PLASMINOGEN,FUNCTIONAL

Facility

$48.00

Service Code	HCPCS 85420
Hospital Charge Code	38473151
Hospital Revenue Code	305
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

PLASMINOGEN,FUNCTIONAL

Facility

$44.90

Service Code	HCPCS 85420
Hospital Charge Code	39900174
Hospital Revenue Code	305
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$6.53
Rate for Payer: Cigna Medicare Advantage	$3.27
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.74
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.92
Rate for Payer: Wellcare Medicare Advantage	$6.53

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.75

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

PLASTIBELL 1.1CM

Facility

$19.96

Hospital Charge Code	270631612
Hospital Revenue Code	270
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99

PLASTIBELL 1.1CM

Facility

$22.45

Hospital Charge Code	270130145
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

PLASTIBELL 1.1CM

Facility

$19.96

Hospital Charge Code	270631612
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$9.98
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.09
Rate for Payer: Cigna Commercial	$9.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$9.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.99
Rate for Payer: UnitedHealthcare Commercial	$9.98

PLASTIBELL 1.1CM

Facility

$22.45

Hospital Charge Code	270130145
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$11.22

PLASTIBELL 1.2CM

Facility

$22.45

Hospital Charge Code	270130150
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

PLASTIBELL 1.2CM

Facility

$22.45

Hospital Charge Code	270130150
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$11.22

PLASTIBELL 1.2CM

Facility

$19.96

Hospital Charge Code	270631613
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$9.98
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.09
Rate for Payer: Cigna Commercial	$9.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$9.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.99
Rate for Payer: UnitedHealthcare Commercial	$9.98

PLASTIBELL 1.2CM

Facility

$19.96

Hospital Charge Code	270631613
Hospital Revenue Code	270
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99

Know your out-of-pocket cost for care.

All Charges