Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROVIGIL 100MG

Facility

$6.00

Hospital Charge Code	60635497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PRO VISC 0.85ml 8065-183085

Facility

$337.35

Hospital Charge Code	270636748
Hospital Revenue Code	272
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$168.68
Rate for Payer: Aetna Commercial	$101.20
Rate for Payer: Aetna Medicare Advantage	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.02
Rate for Payer: Cigna Commercial	$168.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.86
Rate for Payer: Oxford Commercial	$168.68
Rate for Payer: Qualcare PPO/HMO/WC	$50.60
Rate for Payer: UnitedHealthcare Commercial	$168.68

PRO VISC 0.85ml 8065-183085

Facility

$337.35

Hospital Charge Code	270636748
Hospital Revenue Code	272
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$50.60

PROVISC 8065-183055

Facility

$215.00

Hospital Charge Code	270640127
Hospital Revenue Code	272
Min. Negotiated Rate	$27.95
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$64.50
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Oxford Commercial	$107.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$107.50

PROVISC 8065-183055

Facility

$215.00

Hospital Charge Code	270640127
Hospital Revenue Code	272
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$191.34
Max. Negotiated Rate	$735.93
Rate for Payer: Aetna Commercial	$441.56
Rate for Payer: Aetna Medicare Advantage	$441.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.32
Rate for Payer: Cigna Commercial	$735.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.34
Rate for Payer: Oxford Commercial	$735.93
Rate for Payer: Qualcare PPO/HMO/WC	$220.78
Rate for Payer: UnitedHealthcare Commercial	$735.93

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$220.78
Max. Negotiated Rate	$220.78
Rate for Payer: Qualcare PPO/HMO/WC	$220.78

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$147.00
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$316.25
Rate for Payer: Aetna Commercial	$189.75
Rate for Payer: Aetna Medicare Advantage	$189.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.29
Rate for Payer: Cigna Commercial	$316.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.22
Rate for Payer: Oxford Commercial	$316.25
Rate for Payer: Qualcare PPO/HMO/WC	$94.88
Rate for Payer: UnitedHealthcare Commercial	$316.25

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$94.88
Rate for Payer: Qualcare PPO/HMO/WC	$94.88

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$58.50
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$97.50

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$33.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.38

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$111.25
Rate for Payer: Aetna Commercial	$66.75
Rate for Payer: Aetna Medicare Advantage	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.74
Rate for Payer: Cigna Commercial	$111.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.93
Rate for Payer: Oxford Commercial	$111.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.38
Rate for Payer: UnitedHealthcare Commercial	$111.25

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
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) 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	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$246.35
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$568.50
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.35
Rate for Payer: Oxford Commercial	$947.50
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$947.50

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$31,914.40

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$4,787.16
Max. Negotiated Rate	$7,723.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,382.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,723.28
Rate for Payer: Qualcare PPO/HMO/WC	$4,787.16

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$31,914.40

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$4,787.16
Max. Negotiated Rate	$15,957.20
Rate for Payer: Aetna Commercial	$9,574.32
Rate for Payer: Aetna Medicare Advantage	$9,574.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,138.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,138.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,382.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,138.17
Rate for Payer: Cigna Commercial	$15,957.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,723.28
Rate for Payer: Qualcare PPO/HMO/WC	$4,787.16

PROXIMAL IMPLANT 6.5

Facility

$1,575.00

Hospital Charge Code	270656749
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$472.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

PROXIMAL IMPLANT 6.5

Facility

$1,575.00

Hospital Charge Code	270656749
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$102.00
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

Know your out-of-pocket cost for care.

All Charges