Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROZAC/20MG/CAP

Facility

$9.00

Hospital Charge Code	60633780
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PROZAC LIQ 20MG/5ML

Facility

$23.00

Hospital Charge Code	60635203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

PROZAC LIQ 20MG/5ML

Facility

$23.00

Hospital Charge Code	60635203
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

PRP I/HERN INIT BLOCK 5+YR BL

Facility

$54,380.28

Service Code	HCPCS 49507
Hospital Charge Code	160000247
Hospital Revenue Code	360
Min. Negotiated Rate	$8,157.04
Max. Negotiated Rate	$8,157.04
Rate for Payer: Qualcare PPO/HMO/WC	$8,157.04

PRP I/HERN INIT BLOCK 5+YR BL

Facility

$54,380.28

Service Code	HCPCS 49507
Hospital Charge Code	160000247
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$16,314.08
Rate for Payer: Aetna Commercial	$16,314.08
Rate for Payer: Aetna Medicare Advantage	$16,314.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,866.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,866.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,866.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,069.44
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,157.04
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PRPI/HERN INIT REDUC >5YR

Facility

$30,877.00

Service Code	HCPCS 49505
Hospital Charge Code	16000753
Hospital Revenue Code	360
Min. Negotiated Rate	$4,631.55
Max. Negotiated Rate	$4,631.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55

PRPI/HERN INIT REDUC >5YR

Facility

$30,877.00

Service Code	HCPCS 49505
Hospital Charge Code	16000753
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$9,263.10
Rate for Payer: Aetna Commercial	$9,263.10
Rate for Payer: Aetna Medicare Advantage	$9,263.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,873.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,873.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,873.64
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,014.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PRP PREP BIOLOGICAL

Facility

$6,975.00

Hospital Charge Code	270691769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

PRP PREP BIOLOGICAL

Facility

$6,975.00

Hospital Charge Code	270691769
Hospital Revenue Code	272
Min. Negotiated Rate	$906.75
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,092.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.75
Rate for Payer: Oxford Commercial	$3,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$3,487.50

PR PRM ST/0S CP/VE AA DM LN/C

Facility

$35,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270703908
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$8,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00

PR PRM ST/0S CP/VE AA DM LN/C

Facility

$35,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270703908
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$17,500.00
Rate for Payer: Aetna Commercial	$10,500.00
Rate for Payer: Aetna Medicare Advantage	$10,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,925.00
Rate for Payer: Cigna Commercial	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00

PR PRM ST/OSS LH CP/XL AA

Facility

$30,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270704093
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$9,000.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

PR PRM ST/OSS LH CP/XL AA

Facility

$30,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270704093
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

PRQ CARDIAC ANGIO ADDL ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	5100787
Hospital Revenue Code	481
Min. Negotiated Rate	$3,081.13
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$7,110.30
Rate for Payer: Aetna Medicare Advantage	$7,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,043.75
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,081.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRQ CARDIAC ANGIO ADDL ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	74110080
Hospital Revenue Code	481
Min. Negotiated Rate	$3,081.13
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$7,110.30
Rate for Payer: Aetna Medicare Advantage	$7,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,043.75
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,081.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRQ CARDIAC ANGIO ADDL ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	74110080
Hospital Revenue Code	481
Min. Negotiated Rate	$3,555.15
Max. Negotiated Rate	$3,555.15
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15

PRQ CARDIAC ANGIO ADDL ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	5100787
Hospital Revenue Code	481
Min. Negotiated Rate	$3,555.15
Max. Negotiated Rate	$3,555.15
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	366892920
Hospital Revenue Code	481
Min. Negotiated Rate	$3,081.13
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$7,110.30
Rate for Payer: Aetna Medicare Advantage	$7,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,043.75
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,081.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	366892920
Hospital Revenue Code	481
Min. Negotiated Rate	$3,555.15
Max. Negotiated Rate	$3,555.15
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	74110079
Hospital Revenue Code	481
Min. Negotiated Rate	$3,081.13
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$7,110.30
Rate for Payer: Aetna Medicare Advantage	$7,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,043.75
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,081.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	74110079
Hospital Revenue Code	481
Min. Negotiated Rate	$3,555.15
Max. Negotiated Rate	$3,555.15
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	5100786
Hospital Revenue Code	481
Min. Negotiated Rate	$3,081.13
Max. Negotiated Rate	$13,553.85
Rate for Payer: Aetna Commercial	$7,110.30
Rate for Payer: Aetna Medicare Advantage	$7,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,043.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,043.75
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,081.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

PRQ CARDIAC ANGIOPLAT 1 ART

Facility

$23,700.99

Service Code	HCPCS 92920
Hospital Charge Code	5100786
Hospital Revenue Code	481
Min. Negotiated Rate	$3,555.15
Max. Negotiated Rate	$3,555.15
Rate for Payer: Qualcare PPO/HMO/WC	$3,555.15

PRQ CARDI ANGIO/ATHRECT 1 ART

Facility

$45,193.22

Service Code	HCPCS 92924
Hospital Charge Code	74110081
Hospital Revenue Code	481
Min. Negotiated Rate	$6,778.98
Max. Negotiated Rate	$6,778.98
Rate for Payer: Qualcare PPO/HMO/WC	$6,778.98

PRQ CARDI ANGIO/ATHRECT 1 ART

Facility

$45,193.22

Service Code	HCPCS 92924
Hospital Charge Code	74110081
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$13,557.97
Rate for Payer: Aetna Medicare Advantage	$13,557.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,524.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,524.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,524.27
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,875.12
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,778.98
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

Know your out-of-pocket cost for care.

All Charges