Heights University Hospital

All Charges

Charge

Type

Setting

Price

RENT XPS POWER CONSOL SPC LOAN

Facility

$5,000.00

Hospital Charge Code	270639492
Hospital Revenue Code	270
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

RENVELA 0.8GM PWDR

Facility

$112.63

Service Code	NDC 58468013201
Hospital Charge Code	60635733
Hospital Revenue Code	250
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$16.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.89

RENVELA 0.8GM PWDR

Facility

$112.63

Service Code	NDC 58468013201
Hospital Charge Code	60635733
Hospital Revenue Code	250
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$56.31
Rate for Payer: Aetna Commercial	$33.79
Rate for Payer: Aetna Medicare Advantage	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.72
Rate for Payer: Cigna Commercial	$56.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.64
Rate for Payer: Oxford Commercial	$56.31
Rate for Payer: Qualcare PPO/HMO/WC	$16.89
Rate for Payer: UnitedHealthcare Commercial	$56.31

RENVELA 2.4GM PWDR

Facility

$48.24

Service Code	NDC 58468013101
Hospital Charge Code	60635734
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.24

RENVELA 2.4GM PWDR

Facility

$48.24

Service Code	NDC 58468013101
Hospital Charge Code	60635734
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$14.47
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.27
Rate for Payer: Oxford Commercial	$24.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.24
Rate for Payer: UnitedHealthcare Commercial	$24.12

RENVELA 800MG

Facility

$34.17

Service Code	NDC 58468013301
Hospital Charge Code	60635712
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$5.13
Rate for Payer: Qualcare PPO/HMO/WC	$5.13

RENVELA 800MG

Facility

$34.17

Service Code	NDC 58468013301
Hospital Charge Code	60635712
Hospital Revenue Code	250
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$17.09
Rate for Payer: Aetna Commercial	$10.25
Rate for Payer: Aetna Medicare Advantage	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.44
Rate for Payer: Oxford Commercial	$17.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.13
Rate for Payer: UnitedHealthcare Commercial	$17.09

REOPEN FALLOPIAN TUBE

Facility

$32,113.96

Service Code	HCPCS 58350
Hospital Charge Code	160000181
Hospital Revenue Code	360
Min. Negotiated Rate	$4,817.09
Max. Negotiated Rate	$4,817.09
Rate for Payer: Qualcare PPO/HMO/WC	$4,817.09

REOPEN FALLOPIAN TUBE

Facility

$32,113.96

Service Code	HCPCS 58350
Hospital Charge Code	160000181
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,912.81
Rate for Payer: Aetna Commercial	$9,634.19
Rate for Payer: Aetna Medicare Advantage	$9,634.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,189.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,189.06
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	$8,189.06
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.81
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,817.09
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPAGLINIDE 0.5 MG TAB

Facility

$41.61

Service Code	NDC 169008181
Hospital Charge Code	60629853
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$20.80

REPAGLINIDE 0.5 MG TAB

Facility

$41.61

Service Code	NDC 169008181
Hospital Charge Code	60629853
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

REPAGLINIDE 2 MG TAB

Facility

$60.43

Service Code	NDC 60846088401
Hospital Charge Code	60628885
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.06

REPAGLINIDE 2 MG TAB

Facility

$60.43

Service Code	NDC 60846088401
Hospital Charge Code	60628885
Hospital Revenue Code	250
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$30.21
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare Advantage	$18.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$30.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.86
Rate for Payer: Oxford Commercial	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.06
Rate for Payer: UnitedHealthcare Commercial	$30.21

REPAIR ACHILLES TENDON

Facility

$12,289.60

Service Code	HCPCS 27650
Hospital Charge Code	16000217
Hospital Revenue Code	360
Min. Negotiated Rate	$1,597.65
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$3,686.88
Rate for Payer: Aetna Medicare Advantage	$3,686.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.85
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	$3,133.85
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.65
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.44
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

REPAIR ACHILLES TENDON

Facility

$12,289.60

Service Code	HCPCS 27650
Hospital Charge Code	16000217
Hospital Revenue Code	360
Min. Negotiated Rate	$1,843.44
Max. Negotiated Rate	$1,843.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.44

REPAIR ANTERIOR ABD HERNIA,ANY

Facility

$16,538.00

Service Code	HCPCS 49616
Hospital Charge Code	16000161
Hospital Revenue Code	360
Min. Negotiated Rate	$847.32
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$4,961.40
Rate for Payer: Aetna Medicare Advantage	$4,961.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,217.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,217.19
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	$4,217.19
Rate for Payer: Cigna Commercial	$847.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,149.94
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,480.70
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

REPAIR ANTERIOR ABD HERNIA,ANY

Facility

$16,538.00

Service Code	HCPCS 49616
Hospital Charge Code	16000161
Hospital Revenue Code	360
Min. Negotiated Rate	$2,480.70
Max. Negotiated Rate	$2,480.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,480.70

REPAIR BALDDER & VAGINA

Facility

$42,695.42

Service Code	HCPCS 57240
Hospital Charge Code	1600000399
Hospital Revenue Code	360
Min. Negotiated Rate	$6,404.31
Max. Negotiated Rate	$6,404.31
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31

REPAIR BALDDER & VAGINA

Facility

$42,695.42

Service Code	HCPCS 57240
Hospital Charge Code	1600000399
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,808.63
Rate for Payer: Aetna Commercial	$12,808.63
Rate for Payer: Aetna Medicare Advantage	$12,808.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,887.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,887.33
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	$10,887.33
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,550.40
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPAIR BLADDER NECK

Facility

$23,253.84

Service Code	HCPCS 51845
Hospital Charge Code	1600000460
Hospital Revenue Code	360
Min. Negotiated Rate	$3,488.08
Max. Negotiated Rate	$3,488.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,488.08

REPAIR BLADDER NECK

Facility

$23,253.84

Service Code	HCPCS 51845
Hospital Charge Code	1600000460
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,912.81
Rate for Payer: Aetna Commercial	$6,976.15
Rate for Payer: Aetna Medicare Advantage	$6,976.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,929.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,929.73
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	$5,929.73
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,488.08
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

REPAIR BLADDER-VAGINA LESION

Facility

$19,285.59

Service Code	HCPCS 57320
Hospital Charge Code	1600000733
Hospital Revenue Code	360
Min. Negotiated Rate	$2,892.84
Max. Negotiated Rate	$2,892.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,892.84

REPAIR BLADDER-VAGINA LESION

Facility

$19,285.59

Service Code	HCPCS 57320
Hospital Charge Code	1600000733
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,912.81
Rate for Payer: Aetna Commercial	$5,785.68
Rate for Payer: Aetna Medicare Advantage	$5,785.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,917.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,917.83
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	$4,917.83
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,507.13
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,892.84
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPAIR BLD VSL DRCT INTRA-ABD

Facility

$11,691.68

Service Code	HCPCS 35221
Hospital Charge Code	1600000581
Hospital Revenue Code	360
Min. Negotiated Rate	$1,448.34
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$3,507.50
Rate for Payer: Aetna Medicare Advantage	$3,507.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,981.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,981.38
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	$2,981.38
Rate for Payer: Cigna Commercial	$1,448.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,753.75
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPAIR BLD VSL DRCT INTRA-ABD

Facility

$11,691.68

Service Code	HCPCS 35221
Hospital Charge Code	1600000581
Hospital Revenue Code	360
Min. Negotiated Rate	$1,753.75
Max. Negotiated Rate	$1,753.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,753.75

Know your out-of-pocket cost for care.

All Charges