Heights University Hospital

All Charges

Charge

Type

Setting

Price

RAD JAW 4LC W/NDL 240cm 133340

Facility

$74.75

Hospital Charge Code	270638655
Hospital Revenue Code	272
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$11.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.21

RAD JAW 4LC W/NDL 240cm 133340

Facility

$74.75

Hospital Charge Code	270638655
Hospital Revenue Code	272
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$37.38
Rate for Payer: Aetna Commercial	$22.43
Rate for Payer: Aetna Medicare Advantage	$22.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.06
Rate for Payer: Cigna Commercial	$37.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.72
Rate for Payer: Oxford Commercial	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$11.21
Rate for Payer: UnitedHealthcare Commercial	$37.38

RAD JAW 4LC W/O NDL240cm133240

Facility

$46.25

Hospital Charge Code	270638688
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

RAD JAW 4LC W/O NDL240cm133240

Facility

$46.25

Hospital Charge Code	270638688
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$23.12
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$23.12

RAD TREATMENT DEL INTERMEDIATE

Facility

$1,548.50

Service Code	HCPCS 77407
Hospital Charge Code	850000900
Hospital Revenue Code	333
Min. Negotiated Rate	$232.28
Max. Negotiated Rate	$232.28
Rate for Payer: Qualcare PPO/HMO/WC	$232.28

RAD TREATMENT DEL INTERMEDIATE

Facility

$1,548.50

Service Code	HCPCS 77407
Hospital Charge Code	850000900
Hospital Revenue Code	333
Min. Negotiated Rate	$201.31
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$464.55
Rate for Payer: Aetna Medicare Advantage	$464.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.87
Rate for Payer: Cigna Commercial	$918.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.31
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.28
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RAD TREATMENT DELIVERY COMPLEX

Facility

$1,548.50

Service Code	HCPCS 77412
Hospital Charge Code	850000901
Hospital Revenue Code	333
Min. Negotiated Rate	$201.31
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$464.55
Rate for Payer: Aetna Medicare Advantage	$464.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.87
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.31
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.28
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RAD TREATMENT DELIVERY COMPLEX

Facility

$1,548.50

Service Code	HCPCS 77412
Hospital Charge Code	850000901
Hospital Revenue Code	333
Min. Negotiated Rate	$232.28
Max. Negotiated Rate	$232.28
Rate for Payer: Qualcare PPO/HMO/WC	$232.28

RAFN NAIL 11 MM 300

Facility

$7,658.65

Service Code	HCPCS C1713
Hospital Charge Code	270687791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,148.80
Max. Negotiated Rate	$3,829.32
Rate for Payer: Aetna Commercial	$2,297.59
Rate for Payer: Aetna Medicare Advantage	$2,297.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,952.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,952.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,531.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,952.96
Rate for Payer: Cigna Commercial	$3,829.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,853.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,148.80

RAFN NAIL 11 MM 300

Facility

$7,658.65

Service Code	HCPCS C1713
Hospital Charge Code	270687791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,148.80
Max. Negotiated Rate	$1,853.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,531.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,853.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,148.80

RALLY MV AB BONE CEMENT 40 GRA

Facility

$2,334.50

Service Code	HCPCS C1713
Hospital Charge Code	270686906
Hospital Revenue Code	278
Min. Negotiated Rate	$350.18
Max. Negotiated Rate	$564.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$564.95
Rate for Payer: Qualcare PPO/HMO/WC	$350.18

RALLY MV AB BONE CEMENT 40 GRA

Facility

$2,334.50

Service Code	HCPCS C1713
Hospital Charge Code	270686906
Hospital Revenue Code	278
Min. Negotiated Rate	$350.18
Max. Negotiated Rate	$1,167.25
Rate for Payer: Aetna Commercial	$700.35
Rate for Payer: Aetna Medicare Advantage	$700.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$595.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$595.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$595.30
Rate for Payer: Cigna Commercial	$1,167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$564.95
Rate for Payer: Qualcare PPO/HMO/WC	$350.18

RALOXIFENE 60 MG TAB

Facility

$53.06

Service Code	NDC 2418430
Hospital Charge Code	60629016
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.96

RALOXIFENE 60 MG TAB

Facility

$53.06

Service Code	NDC 2418430
Hospital Charge Code	60629016
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$26.53
Rate for Payer: Aetna Commercial	$15.92
Rate for Payer: Aetna Medicare Advantage	$15.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.53
Rate for Payer: Cigna Commercial	$26.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$7.96
Rate for Payer: UnitedHealthcare Commercial	$26.53

RALOXIFENE 60MG TAB

Facility

$47.77

Service Code	NDC 69097082502
Hospital Charge Code	6063943401
Hospital Revenue Code	250
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$23.89
Rate for Payer: Aetna Commercial	$14.33
Rate for Payer: Aetna Medicare Advantage	$14.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.18
Rate for Payer: Cigna Commercial	$23.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.21
Rate for Payer: Oxford Commercial	$23.89
Rate for Payer: Qualcare PPO/HMO/WC	$7.17
Rate for Payer: UnitedHealthcare Commercial	$23.89

RALOXIFENE 60MG TAB

Facility

$47.77

Service Code	NDC 69097082502
Hospital Charge Code	6063943401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$7.17

RALTEGRAVIR 100MG CHEWABLE

Facility

$40.33

Service Code	NDC 6047761
Hospital Charge Code	6000428
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna Commercial	$12.10
Rate for Payer: Aetna Medicare Advantage	$12.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.28
Rate for Payer: Cigna Commercial	$20.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.24
Rate for Payer: Oxford Commercial	$20.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$20.16

RALTEGRAVIR 100MG CHEWABLE

Facility

$40.33

Service Code	NDC 6047761
Hospital Charge Code	6000428
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

RALTEGRAVIR 400MG TAB

Facility

$161.40

Service Code	NDC 6022761
Hospital Charge Code	60630217
Hospital Revenue Code	250
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$80.70
Rate for Payer: Aetna Commercial	$48.42
Rate for Payer: Aetna Medicare Advantage	$48.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.16
Rate for Payer: Cigna Commercial	$80.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.98
Rate for Payer: Oxford Commercial	$80.70
Rate for Payer: Qualcare PPO/HMO/WC	$24.21
Rate for Payer: UnitedHealthcare Commercial	$80.70

RALTEGRAVIR 400MG TAB

Facility

$161.40

Service Code	NDC 6022761
Hospital Charge Code	60630217
Hospital Revenue Code	250
Min. Negotiated Rate	$24.21
Max. Negotiated Rate	$24.21
Rate for Payer: Qualcare PPO/HMO/WC	$24.21

RAM GUIDE 455MM

Facility

$2,127.00

Hospital Charge Code	270673458
Hospital Revenue Code	272
Min. Negotiated Rate	$319.05
Max. Negotiated Rate	$319.05
Rate for Payer: Qualcare PPO/HMO/WC	$319.05

RAM GUIDE 455MM

Facility

$2,127.00

Hospital Charge Code	270673458
Hospital Revenue Code	272
Min. Negotiated Rate	$276.51
Max. Negotiated Rate	$1,063.50
Rate for Payer: Aetna Commercial	$638.10
Rate for Payer: Aetna Medicare Advantage	$638.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$542.38
Rate for Payer: Cigna Commercial	$1,063.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.51
Rate for Payer: Oxford Commercial	$1,063.50
Rate for Payer: Qualcare PPO/HMO/WC	$319.05
Rate for Payer: UnitedHealthcare Commercial	$1,063.50

RAMIPRIL 1.25 MG CAP

Facility

$9.72

Service Code	NDC 16252057030
Hospital Charge Code	60627610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

RAMIPRIL 1.25 MG CAP

Facility

$9.72

Service Code	NDC 16252057030
Hospital Charge Code	60627610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.48
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.26
Rate for Payer: Oxford Commercial	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$4.86

RAMIPRIL 2.5 MG CAP

Facility

$13.00

Service Code	NDC 68084026601
Hospital Charge Code	60629223
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

Know your out-of-pocket cost for care.

All Charges