Heights University Hospital

All Charges

Charge

Type

Setting

Price

RETROVIR/10MG/1ML

Facility

$4.00

Service Code	NDC 65862004824
Hospital Charge Code	60633821
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

RETROVIR IV

Facility

$122.00

Hospital Charge Code	60635062
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$36.60
Rate for Payer: Aetna Medicare Advantage	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.11
Rate for Payer: Cigna Commercial	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.30
Rate for Payer: UnitedHealthcare Commercial	$61.00

RETROVIR IV

Facility

$122.00

Hospital Charge Code	60635062
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

REVASC LITHOTR-STENT TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9773
Hospital Charge Code	4110C9773
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$29,662.42
Rate for Payer: Aetna Medicare Advantage	$29,662.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,213.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,213.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,213.06
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,853.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

REVASC LITHOTR-STENT TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9773
Hospital Charge Code	4110C9773
Hospital Revenue Code	480
Min. Negotiated Rate	$14,831.21
Max. Negotiated Rate	$14,831.21
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21

REVASC LITH-STEN-ATH TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9775
Hospital Charge Code	4110C9775
Hospital Revenue Code	480
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$29,662.42
Rate for Payer: Aetna Medicare Advantage	$29,662.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,213.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,213.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,213.06
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,853.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

REVASC LITH-STEN-ATH TIB/PER

Facility

$98,874.75

Service Code	HCPCS C9775
Hospital Charge Code	4110C9775
Hospital Revenue Code	480
Min. Negotiated Rate	$14,831.21
Max. Negotiated Rate	$14,831.21
Rate for Payer: Qualcare PPO/HMO/WC	$14,831.21

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$63.31
Max. Negotiated Rate	$243.50
Rate for Payer: Aetna Commercial	$146.10
Rate for Payer: Aetna Medicare Advantage	$146.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.19
Rate for Payer: Cigna Commercial	$243.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.31
Rate for Payer: Oxford Commercial	$243.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.05
Rate for Payer: UnitedHealthcare Commercial	$243.50

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$73.05
Max. Negotiated Rate	$73.05
Rate for Payer: Qualcare PPO/HMO/WC	$73.05

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$4,455.75
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$4,455.75
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW AND STD

Facility

$7,711.30

Service Code	HCPCS C1776
Hospital Charge Code	270691400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.69
Max. Negotiated Rate	$3,855.65
Rate for Payer: Aetna Commercial	$2,313.39
Rate for Payer: Aetna Medicare Advantage	$2,313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,966.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,966.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,542.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,966.38
Rate for Payer: Cigna Commercial	$3,855.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,156.69

REVERSE BODY SCREW AND STD

Facility

$7,711.30

Service Code	HCPCS C1776
Hospital Charge Code	270691400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.69
Max. Negotiated Rate	$1,866.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,542.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,156.69

REVERSE BODY SCREW TITAN

Facility

$12,205.55

Service Code	HCPCS C1713
Hospital Charge Code	270691467
Hospital Revenue Code	278
Min. Negotiated Rate	$1,830.83
Max. Negotiated Rate	$6,102.77
Rate for Payer: Aetna Commercial	$3,661.66
Rate for Payer: Aetna Medicare Advantage	$3,661.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,441.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,112.42
Rate for Payer: Cigna Commercial	$6,102.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,953.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,830.83

REVERSE BODY SCREW TITAN

Facility

$12,205.55

Service Code	HCPCS C1713
Hospital Charge Code	270691467
Hospital Revenue Code	278
Min. Negotiated Rate	$1,830.83
Max. Negotiated Rate	$2,953.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,441.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,953.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,830.83

REVERSE BODY SMALL & SCREW

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270688777
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SMALL & SCREW

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270688777
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$4,455.75
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE SHOULDER SYSTEM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270704899
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

REVERSE SHOULDER SYSTEM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270704899
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

REV GJ ANASTOM WO VAGOT

Facility

$8,727.00

Service Code	HCPCS 43860
Hospital Charge Code	16000968
Hospital Revenue Code	360
Min. Negotiated Rate	$1,134.51
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$2,618.10
Rate for Payer: Aetna Medicare Advantage	$2,618.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,225.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,225.39
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	$2,225.39
Rate for Payer: Cigna Commercial	$1,649.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,134.51
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,309.05
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REV GJ ANASTOM WO VAGOT

Facility

$8,727.00

Service Code	HCPCS 43860
Hospital Charge Code	16000968
Hospital Revenue Code	360
Min. Negotiated Rate	$1,309.05
Max. Negotiated Rate	$1,309.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,309.05

Know your out-of-pocket cost for care.

All Charges