Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROSTHESIS SPECT 650CC

Facility

$3,830.45

Hospital Charge Code	270603853
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 650CC

Facility

$3,830.45

Hospital Charge Code	270603853
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,149.13
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECTRA 9.5MM 20CM

Facility

$37,840.90

Service Code	HCPCS C1776
Hospital Charge Code	270674898
Hospital Revenue Code	278
Min. Negotiated Rate	$5,676.14
Max. Negotiated Rate	$18,920.45
Rate for Payer: Aetna Commercial	$11,352.27
Rate for Payer: Aetna Medicare Advantage	$11,352.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,649.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,649.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,568.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,649.43
Rate for Payer: Cigna Commercial	$18,920.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,157.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,676.14

PROSTHESIS SPECTRA 9.5MM 20CM

Facility

$37,840.90

Service Code	HCPCS C1776
Hospital Charge Code	270674898
Hospital Revenue Code	278
Min. Negotiated Rate	$5,676.14
Max. Negotiated Rate	$9,157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,568.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,157.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,676.14

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$24.57
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
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	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.57
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$686.00

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
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	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$39.15
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
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	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.96
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$686.00

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$39.15
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
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	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.96
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$686.00

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
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	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROSTHSIS GLDBRG MIDEAR 140964

Facility

$2,782.45

Hospital Charge Code	270621215
Hospital Revenue Code	272
Min. Negotiated Rate	$361.72
Max. Negotiated Rate	$1,391.22
Rate for Payer: Aetna Commercial	$834.74
Rate for Payer: Aetna Medicare Advantage	$834.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$709.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$709.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$709.52
Rate for Payer: Cigna Commercial	$1,391.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.72
Rate for Payer: Oxford Commercial	$1,391.22
Rate for Payer: Qualcare PPO/HMO/WC	$417.37
Rate for Payer: UnitedHealthcare Commercial	$1,391.22

PROSTHSIS GLDBRG MIDEAR 140964

Facility

$2,782.45

Hospital Charge Code	270621215
Hospital Revenue Code	272
Min. Negotiated Rate	$417.37
Max. Negotiated Rate	$417.37
Rate for Payer: Qualcare PPO/HMO/WC	$417.37

PROSTIGMIN 1:2000/10ML

Facility

$66.00

Hospital Charge Code	60633768
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

PROSTIGMIN 1:2000/10ML

Facility

$66.00

Hospital Charge Code	60633768
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

PROSTIGMIN 1:2000/1ML

Facility

$8.00

Hospital Charge Code	60633767
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

PROSTIGMIN 1:2000/1ML

Facility

$8.00

Hospital Charge Code	60633767
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

PROSTIGMIN 1:4000/1ML

Facility

$6.00

Hospital Charge Code	60633769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

PROSTIGMIN 1:4000/1ML

Facility

$6.00

Hospital Charge Code	60633769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270656819
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270656819
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$424.23
Max. Negotiated Rate	$424.23
Rate for Payer: Qualcare PPO/HMO/WC	$424.23

Know your out-of-pocket cost for care.

All Charges