Heights University Hospital

All Charges

Charge

Type

Setting

Price

RESP SODIUM

Facility

$47.25

Hospital Charge Code	9509015
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

RESP SURFACTANT ADM-INTRAPULMO

Facility

$176.55

Service Code	HCPCS 94610
Hospital Charge Code	9507001
Hospital Revenue Code	469
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$52.97
Rate for Payer: Aetna Medicare Advantage	$52.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.02
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.95
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.48
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

RESP SURFACTANT ADM-INTRAPULMO

Facility

$176.55

Service Code	HCPCS 94610
Hospital Charge Code	9507001
Hospital Revenue Code	469
Min. Negotiated Rate	$26.48
Max. Negotiated Rate	$26.48
Rate for Payer: Qualcare PPO/HMO/WC	$26.48

RESP SYNCTIAL VIRUS AG (RSV)

Facility

$231.25

Service Code	HCPCS 87280
Hospital Charge Code	3006715
Hospital Revenue Code	309
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.48
Rate for Payer: Aetna Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.17
Rate for Payer: Cigna Commercial	$13.42
Rate for Payer: Cigna Medicare Advantage	$6.71
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.23
Rate for Payer: Wellcare Medicare Advantage	$13.42

RESP SYNCTIAL VIRUS AG (RSV)

Facility

$231.25

Service Code	HCPCS 87280
Hospital Charge Code	3006715
Hospital Revenue Code	309
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

RESP. SYNCYTIAL VIRUS AG

Facility

$667.59

Service Code	HCPCS 87807
Hospital Charge Code	3036055
Hospital Revenue Code	306
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.44
Rate for Payer: Aetna Medicare Advantage	$13.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.00
Rate for Payer: Cigna Commercial	$13.10
Rate for Payer: Cigna Medicare Advantage	$6.55
Rate for Payer: Clover Medicare Advantage	$12.45
Rate for Payer: EmblemHealth Commercial	$39.30
Rate for Payer: Humana Medicare Advantage	$13.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.89
Rate for Payer: Wellcare Medicare Advantage	$13.10

RESP. SYNCYTIAL VIRUS AG

Facility

$667.59

Service Code	HCPCS 87807
Hospital Charge Code	3036055
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RESRVR CEREBROSPINAL FLD 44105

Facility

$1,881.60

Hospital Charge Code	270659679
Hospital Revenue Code	278
Min. Negotiated Rate	$282.24
Max. Negotiated Rate	$940.80
Rate for Payer: Aetna Commercial	$564.48
Rate for Payer: Aetna Medicare Advantage	$564.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.81
Rate for Payer: Cigna Commercial	$940.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.35
Rate for Payer: Qualcare PPO/HMO/WC	$282.24

RESRVR CEREBROSPINAL FLD 44105

Facility

$1,881.60

Hospital Charge Code	270659679
Hospital Revenue Code	278
Min. Negotiated Rate	$282.24
Max. Negotiated Rate	$455.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.35
Rate for Payer: Qualcare PPO/HMO/WC	$282.24

RESTON

Facility

$845.65

Hospital Charge Code	270606039
Hospital Revenue Code	270
Min. Negotiated Rate	$126.85
Max. Negotiated Rate	$126.85
Rate for Payer: Qualcare PPO/HMO/WC	$126.85

RESTON

Facility

$845.65

Hospital Charge Code	270606039
Hospital Revenue Code	270
Min. Negotiated Rate	$109.93
Max. Negotiated Rate	$422.82
Rate for Payer: Aetna Commercial	$253.69
Rate for Payer: Aetna Medicare Advantage	$253.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.64
Rate for Payer: Cigna Commercial	$422.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.93
Rate for Payer: Oxford Commercial	$422.82
Rate for Payer: Qualcare PPO/HMO/WC	$126.85
Rate for Payer: UnitedHealthcare Commercial	$422.82

RESTON ************

Facility

$81.00

Hospital Charge Code	8001513
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

RESTON ************

Facility

$81.00

Hospital Charge Code	8001513
Hospital Revenue Code	279
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$40.50

RESTORAT ADM/MDM 28/52MM SZ46F

Facility

$3,361.40

Service Code	HCPCS C1776
Hospital Charge Code	270699691
Hospital Revenue Code	278
Min. Negotiated Rate	$504.21
Max. Negotiated Rate	$813.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.46
Rate for Payer: Qualcare PPO/HMO/WC	$504.21

RESTORAT ADM/MDM 28/52MM SZ46F

Facility

$3,361.40

Service Code	HCPCS C1776
Hospital Charge Code	270699691
Hospital Revenue Code	278
Min. Negotiated Rate	$504.21
Max. Negotiated Rate	$1,680.70
Rate for Payer: Aetna Commercial	$1,008.42
Rate for Payer: Aetna Medicare Advantage	$1,008.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$857.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$857.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$857.16
Rate for Payer: Cigna Commercial	$1,680.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.46
Rate for Payer: Qualcare PPO/HMO/WC	$504.21

RESTORE INSTRUMENT SET MITEK

Facility

$1,500.00

Hospital Charge Code	270645770
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

RESTORE INSTRUMENT SET MITEK

Facility

$1,500.00

Hospital Charge Code	270645770
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

RESTORE PROLYSTICA

Facility

$217.20

Hospital Charge Code	270666125
Hospital Revenue Code	270
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$108.60
Rate for Payer: Aetna Commercial	$65.16
Rate for Payer: Aetna Medicare Advantage	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.39
Rate for Payer: Cigna Commercial	$108.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.24
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$32.58
Rate for Payer: UnitedHealthcare Commercial	$108.60

RESTORE PROLYSTICA

Facility

$217.20

Hospital Charge Code	270666125
Hospital Revenue Code	270
Min. Negotiated Rate	$32.58
Max. Negotiated Rate	$32.58
Rate for Payer: Qualcare PPO/HMO/WC	$32.58

Restore Ssnsor

Facility

$93,750.00

Service Code	HCPCS C1767
Hospital Charge Code	270647769
Hospital Revenue Code	278
Min. Negotiated Rate	$14,062.50
Max. Negotiated Rate	$46,875.00
Rate for Payer: Aetna Commercial	$28,125.00
Rate for Payer: Aetna Medicare Advantage	$28,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,906.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,906.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,906.25
Rate for Payer: Cigna Commercial	$46,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,687.50
Rate for Payer: Qualcare PPO/HMO/WC	$14,062.50

Restore Ssnsor

Facility

$93,750.00

Service Code	HCPCS C1767
Hospital Charge Code	270647769
Hospital Revenue Code	278
Min. Negotiated Rate	$14,062.50
Max. Negotiated Rate	$22,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,687.50
Rate for Payer: Qualcare PPO/HMO/WC	$14,062.50

RESTOREULTRA 37712

Facility

$117,187.50

Hospital Charge Code	270640323
Hospital Revenue Code	278
Min. Negotiated Rate	$17,578.12
Max. Negotiated Rate	$58,593.75
Rate for Payer: Aetna Commercial	$35,156.25
Rate for Payer: Aetna Medicare Advantage	$35,156.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,882.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,882.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,882.81
Rate for Payer: Cigna Commercial	$58,593.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,359.38
Rate for Payer: Qualcare PPO/HMO/WC	$17,578.12

RESTOREULTRA 37712

Facility

$117,187.50

Hospital Charge Code	270640323
Hospital Revenue Code	278
Min. Negotiated Rate	$17,578.12
Max. Negotiated Rate	$28,359.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,359.38
Rate for Payer: Qualcare PPO/HMO/WC	$17,578.12

RESTORIGIN AMNIOT FLUID XL 2ML

Facility

$7,475.00

Service Code	HCPCS Q4192
Hospital Charge Code	270694943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

RESTORIGIN AMNIOT FLUID XL 2ML

Facility

$7,475.00

Service Code	HCPCS Q4192
Hospital Charge Code	270694943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,242.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

Know your out-of-pocket cost for care.

All Charges