Heights University Hospital

All Charges

Charge

Type

Setting

Price

PORACTANT ALFA 80 MG/ML(1.5ML)

Facility

$2,457.96

Hospital Charge Code	6063943232
Hospital Revenue Code	250
Min. Negotiated Rate	$368.69
Max. Negotiated Rate	$368.69
Rate for Payer: Qualcare PPO/HMO/WC	$368.69

PORACTANT ALFA 80 MG/ML(1.5ML)

Facility

$2,457.96

Hospital Charge Code	6063943232
Hospital Revenue Code	250
Min. Negotiated Rate	$319.53
Max. Negotiated Rate	$1,228.98
Rate for Payer: Aetna Commercial	$737.39
Rate for Payer: Aetna Medicare Advantage	$737.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.78
Rate for Payer: Cigna Commercial	$1,228.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.53
Rate for Payer: Oxford Commercial	$1,228.98
Rate for Payer: Qualcare PPO/HMO/WC	$368.69
Rate for Payer: UnitedHealthcare Commercial	$1,228.98

PORACTANT ALFA 80 MG/ML(3ML)

Facility

$9,495.91

Service Code	NDC 10122051003
Hospital Charge Code	6063943233
Hospital Revenue Code	250
Min. Negotiated Rate	$1,424.39
Max. Negotiated Rate	$1,424.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,424.39

PORACTANT ALFA 80 MG/ML(3ML)

Facility

$9,495.91

Service Code	NDC 10122051003
Hospital Charge Code	6063943233
Hospital Revenue Code	250
Min. Negotiated Rate	$1,234.47
Max. Negotiated Rate	$4,747.95
Rate for Payer: Aetna Commercial	$2,848.77
Rate for Payer: Aetna Medicare Advantage	$2,848.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,421.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,421.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,421.46
Rate for Payer: Cigna Commercial	$4,747.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,234.47
Rate for Payer: Oxford Commercial	$4,747.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,424.39
Rate for Payer: UnitedHealthcare Commercial	$4,747.95

POROUS COATED INTERBODY 10X27X

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704666
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$6,000.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

POROUS COATED INTERBODY 10X27X

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704666
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

POROUS IM STEM 15.5X150

Facility

$11,820.00

Service Code	HCPCS C1776
Hospital Charge Code	270673873
Hospital Revenue Code	278
Min. Negotiated Rate	$1,773.00
Max. Negotiated Rate	$2,860.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,364.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,860.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00

POROUS IM STEM 15.5X150

Facility

$11,820.00

Service Code	HCPCS C1776
Hospital Charge Code	270673873
Hospital Revenue Code	278
Min. Negotiated Rate	$1,773.00
Max. Negotiated Rate	$5,910.00
Rate for Payer: Aetna Commercial	$3,546.00
Rate for Payer: Aetna Medicare Advantage	$3,546.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,364.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,014.10
Rate for Payer: Cigna Commercial	$5,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,860.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00

PORPHOBILINOGEN****

Facility

$27.00

Hospital Charge Code	3012135
Hospital Revenue Code	309
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

PORPHOBILINOGEN****

Facility

$27.00

Hospital Charge Code	3012135
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

PORPHOBILINOGEN,24HR

Facility

$85.00

Service Code	HCPCS 84110
Hospital Charge Code	38479121
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

PORPHOBILINOGEN,24HR

Facility

$85.00

Service Code	HCPCS 84110
Hospital Charge Code	38479121
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.35
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.92
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: Cigna Medicare Advantage	$4.22
Rate for Payer: Clover Medicare Advantage	$8.02
Rate for Payer: EmblemHealth Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$8.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.44
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.95
Rate for Payer: Wellcare Medicare Advantage	$8.44

PORPHOBILINOGEN, URINE

Facility

$85.00

Service Code	HCPCS 84106
Hospital Charge Code	38472545
Hospital Revenue Code	301
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

PORPHOBILINOGEN, URINE

Facility

$85.00

Service Code	HCPCS 84106
Hospital Charge Code	38472545
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

PORPHOBILINOGEN,URINE I

Facility

$29.40

Service Code	HCPCS 84106
Hospital Charge Code	39990017A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.41
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

PORPHOBILINOGEN,URINE I

Facility

$29.40

Service Code	HCPCS 84106
Hospital Charge Code	39990017A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.41

PORPHOBILINOGEN,URINE II

Facility

$58.00

Service Code	HCPCS 84110
Hospital Charge Code	39990017B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

PORPHOBILINOGEN,URINE II

Facility

$58.00

Service Code	HCPCS 84110
Hospital Charge Code	39990017B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.35
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.92
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: Cigna Medicare Advantage	$4.22
Rate for Payer: Clover Medicare Advantage	$8.02
Rate for Payer: EmblemHealth Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$8.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.44
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.95
Rate for Payer: Wellcare Medicare Advantage	$8.44

PORPHOBILINOGEN URINE QUAL

Facility

$30.00

Service Code	HCPCS 84106
Hospital Charge Code	38477028
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

PORPHOBILINOGEN URINE QUAL

Facility

$30.00

Service Code	HCPCS 84106
Hospital Charge Code	38477028
Hospital Revenue Code	301
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

PORPHOBILINOGEN, URINE QUANT

Facility

$91.25

Service Code	HCPCS 84110
Hospital Charge Code	3002136
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PORPHOBILINOGEN, URINE QUANT

Facility

$91.25

Service Code	HCPCS 84110
Hospital Charge Code	3002136
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.35
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.92
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: Cigna Medicare Advantage	$4.22
Rate for Payer: Clover Medicare Advantage	$8.02
Rate for Payer: EmblemHealth Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$8.69
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	$8.44
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.95
Rate for Payer: Wellcare Medicare Advantage	$8.44

PORPHYRINS 24 HR URINE A

Facility

$390.00

Service Code	HCPCS 84120
Hospital Charge Code	397080010A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PORPHYRINS 24 HR URINE A

Facility

$390.00

Service Code	HCPCS 84120
Hospital Charge Code	397080010A
Hospital Revenue Code	301
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.66
Rate for Payer: Aetna Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.90
Rate for Payer: Cigna Commercial	$14.71
Rate for Payer: Cigna Medicare Advantage	$7.36
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
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	$14.71
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.59
Rate for Payer: Wellcare Medicare Advantage	$14.71

PORPHYRINS 24 HR URINE B

Facility

$390.00

Service Code	HCPCS 84110
Hospital Charge Code	397080010B
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