Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSA Disposible Cable

Facility

$303.75

Hospital Charge Code	270666011N
Hospital Revenue Code	272
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$45.56

PSA FREE

Facility

$281.00

Service Code	HCPCS 84154
Hospital Charge Code	38472582
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA FREE

Facility

$281.00

Service Code	HCPCS 84154
Hospital Charge Code	38472582
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

PSA FREE AND TOTAL I

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39990074A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
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	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA FREE AND TOTAL I

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39990074A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA FREE AND TOTAL II

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	39990074B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
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	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA FREE AND TOTAL II

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	39990074B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39708029
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
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	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	366884153
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39708029
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	366884153
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
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	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$157.95

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$136.89
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$315.90
Rate for Payer: Aetna Medicare Advantage	$315.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$268.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$268.51
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	$268.51
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.89
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.95
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$18.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.97

PSA ULTRA SENSITIVE

Facility

$141.40

Service Code	HCPCS 84153
Hospital Charge Code	3030560
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.21
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PSA ULTRA SENSITIVE

Facility

$141.40

Service Code	HCPCS 84153
Hospital Charge Code	3030560
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$21.21
Rate for Payer: Qualcare PPO/HMO/WC	$21.21

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$430.97
Max. Negotiated Rate	$430.97
Rate for Payer: Qualcare PPO/HMO/WC	$430.97

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$373.51
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$861.95
Rate for Payer: Aetna Medicare Advantage	$861.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.66
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	$732.66
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.51
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$430.97
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

PSEUDOEP HCL SYR 6MG/1 ML

Facility

$0.08

Hospital Charge Code	60635740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.02
Rate for Payer: Cigna Commercial	$0.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Oxford Commercial	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Commercial	$0.04

PSEUDOEP HCL SYR 6MG/1 ML

Facility

$0.08

Hospital Charge Code	60635740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

PSEUDOEPHEDRINE 30 MG/5 ML LIQ

Facility

$4.00

Service Code	NDC 536185085
Hospital Charge Code	60628982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSEUDOEPHEDRINE 30 MG/5 ML LIQ

Facility

$4.00

Service Code	NDC 536185085
Hospital Charge Code	60628982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PSEUDOEPHEDRINE/30MG/TAB

Facility

$3.00

Hospital Charge Code	60633785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PSEUDOEPHEDRINE/30MG/TAB

Facility

$1.00

Hospital Charge Code	60633783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

Know your out-of-pocket cost for care.

All Charges