Heights University Hospital

All Charges

Charge

Type

Setting

Price

PRODUCT FACTOR 8

Facility

$240.85

Hospital Charge Code	3100328
Hospital Revenue Code	636
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

PRODUCT FACTOR 8

Facility

$240.85

Hospital Charge Code	3100328
Hospital Revenue Code	636
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$72.25
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

PRODUCTFRESH FROZEN PLASMA

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	3100922
Hospital Revenue Code	390
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

PRODUCTFRESH FROZEN PLASMA

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	3100922
Hospital Revenue Code	390
Min. Negotiated Rate	$45.81
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$105.70
Rate for Payer: Aetna Medicare Advantage	$105.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.85
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.81
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT IRRAD PLATELETPHERESIS

Facility

$2,392.35

Hospital Charge Code	3100971
Hospital Revenue Code	390
Min. Negotiated Rate	$358.85
Max. Negotiated Rate	$358.85
Rate for Payer: Qualcare PPO/HMO/WC	$358.85

PRODUCT IRRAD PLATELETPHERESIS

Facility

$2,392.35

Hospital Charge Code	3100971
Hospital Revenue Code	390
Min. Negotiated Rate	$311.01
Max. Negotiated Rate	$1,196.17
Rate for Payer: Aetna Commercial	$717.71
Rate for Payer: Aetna Medicare Advantage	$717.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.05
Rate for Payer: Cigna Commercial	$1,196.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.01
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$358.85
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT LEUK CONCENTRATE

Facility

$190.45

Hospital Charge Code	3100088
Hospital Revenue Code	399
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT LEUK CONCENTRATE

Facility

$190.45

Hospital Charge Code	3100088
Hospital Revenue Code	399
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

PRODUCT WASHED RBC

Facility

$529.95

Hospital Charge Code	3100096
Hospital Revenue Code	390
Min. Negotiated Rate	$79.49
Max. Negotiated Rate	$79.49
Rate for Payer: Qualcare PPO/HMO/WC	$79.49

PRODUCT WASHED RBC

Facility

$529.95

Hospital Charge Code	3100096
Hospital Revenue Code	390
Min. Negotiated Rate	$68.89
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$158.99
Rate for Payer: Aetna Medicare Advantage	$158.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.14
Rate for Payer: Cigna Commercial	$264.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.89
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.49
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT WHOLE BLOOD

Facility

$405.15

Hospital Charge Code	3100278
Hospital Revenue Code	390
Min. Negotiated Rate	$52.67
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$121.55
Rate for Payer: Aetna Medicare Advantage	$121.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.31
Rate for Payer: Cigna Commercial	$202.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.67
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.77
Rate for Payer: UnitedHealthcare Commercial	$756.00

PRODUCT WHOLE BLOOD

Facility

$405.15

Hospital Charge Code	3100278
Hospital Revenue Code	390
Min. Negotiated Rate	$60.77
Max. Negotiated Rate	$60.77
Rate for Payer: Qualcare PPO/HMO/WC	$60.77

PROE 617GA LUMB DISC407250000

Facility

$9,205.85

Hospital Charge Code	270636252
Hospital Revenue Code	272
Min. Negotiated Rate	$1,380.88
Max. Negotiated Rate	$1,380.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.88

PROE 617GA LUMB DISC407250000

Facility

$9,205.85

Hospital Charge Code	270636252
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.76
Max. Negotiated Rate	$4,602.93
Rate for Payer: Aetna Commercial	$2,761.76
Rate for Payer: Aetna Medicare Advantage	$2,761.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,347.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,347.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,347.49
Rate for Payer: Cigna Commercial	$4,602.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,196.76
Rate for Payer: Oxford Commercial	$4,602.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.88
Rate for Payer: UnitedHealthcare Commercial	$4,602.93

PROGESTASER INSERTION WHC*****

Facility

$123.00

Service Code	HCPCS W0002WF
Hospital Charge Code	9600019
Hospital Revenue Code	519
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

PROGESTASER INSERTION WHC*****

Facility

$123.00

Service Code	HCPCS W0002WF
Hospital Charge Code	9600019
Hospital Revenue Code	519
Min. Negotiated Rate	$15.99
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$36.90
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.99
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

PROGESTERONE

Facility

$866.00

Service Code	HCPCS 84144
Hospital Charge Code	38472563
Hospital Revenue Code	301
Min. Negotiated Rate	$129.90
Max. Negotiated Rate	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$129.90

PROGESTERONE

Facility

$866.00

Service Code	HCPCS 84144
Hospital Charge Code	38472563
Hospital Revenue Code	301
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$129.90
Rate for Payer: Aetna Commercial	$67.59
Rate for Payer: Aetna Medicare Advantage	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.43
Rate for Payer: Cigna Commercial	$20.86
Rate for Payer: Cigna Medicare Advantage	$10.43
Rate for Payer: Clover Medicare Advantage	$19.82
Rate for Payer: EmblemHealth Commercial	$62.58
Rate for Payer: Humana Medicare Advantage	$21.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.11
Rate for Payer: Wellcare Medicare Advantage	$20.86

PROGESTERONE

Facility

$390.00

Service Code	HCPCS 84144
Hospital Charge Code	39900447
Hospital Revenue Code	301
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.59
Rate for Payer: Aetna Medicare Advantage	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.43
Rate for Payer: Cigna Commercial	$20.86
Rate for Payer: Cigna Medicare Advantage	$10.43
Rate for Payer: Clover Medicare Advantage	$19.82
Rate for Payer: EmblemHealth Commercial	$62.58
Rate for Payer: Humana Medicare Advantage	$21.49
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	$20.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.11
Rate for Payer: Wellcare Medicare Advantage	$20.86

PROGESTERONE

Facility

$390.00

Service Code	HCPCS 84144
Hospital Charge Code	39900447
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROGESTERONE 50 MG/ML INJ

Facility

$16.00

Hospital Charge Code	6004675
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

PROGESTERONE 50 MG/ML INJ

Facility

$16.00

Hospital Charge Code	6004675
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.00

PROGESTERONE INJ

Facility

$89.00

Hospital Charge Code	60635063
Hospital Revenue Code	636
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

PROGESTERONE INJ

Facility

$89.00

Hospital Charge Code	60635063
Hospital Revenue Code	636
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$21.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

PROGESTERONE OIL MDV 50MG/10ML

Facility

$14.85

Hospital Charge Code	60629834
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare Advantage	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.79
Rate for Payer: Cigna Commercial	$7.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.93
Rate for Payer: Oxford Commercial	$7.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$7.42

Know your out-of-pocket cost for care.

All Charges