Heights University Hospital

All Charges

Charge

Type

Setting

Price

REVSC EVSC TPVT ANGIO SF 1ST

Facility

$52,548.60

Service Code	HCPCS 37280
Hospital Charge Code	404637280
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$15,764.58
Rate for Payer: Aetna Medicare Advantage	$15,764.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,399.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,399.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,399.89
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,831.32
Rate for Payer: Qualcare PPO/HMO/WC	$7,882.29

REVSC EVSC TPVT ANGIO SF 1ST

Facility

$80,096.45

Service Code	HCPCS 37277
Hospital Charge Code	403437277
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$24,028.94
Rate for Payer: Aetna Medicare Advantage	$24,028.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,424.59
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,412.54
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC CPLX 1

Facility

$80,096.45

Service Code	HCPCS 37290
Hospital Charge Code	403437290
Hospital Revenue Code	481
Min. Negotiated Rate	$12,014.47
Max. Negotiated Rate	$12,014.47
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC CPLX 1

Facility

$80,096.45

Service Code	HCPCS 37290
Hospital Charge Code	404637290
Hospital Revenue Code	481
Min. Negotiated Rate	$12,014.47
Max. Negotiated Rate	$12,014.47
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC CPLX 1

Facility

$80,096.45

Service Code	HCPCS 37290
Hospital Charge Code	404637290
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$24,028.94
Rate for Payer: Aetna Medicare Advantage	$24,028.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,424.59
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,412.54
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC CPLX 1

Facility

$80,096.45

Service Code	HCPCS 37290
Hospital Charge Code	403437290
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$24,028.94
Rate for Payer: Aetna Medicare Advantage	$24,028.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,424.59
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,412.54
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC SF 1ST

Facility

$80,096.45

Service Code	HCPCS 37288
Hospital Charge Code	403437288
Hospital Revenue Code	481
Min. Negotiated Rate	$12,014.47
Max. Negotiated Rate	$12,014.47
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC SF 1ST

Facility

$80,096.45

Service Code	HCPCS 37288
Hospital Charge Code	404637288
Hospital Revenue Code	481
Min. Negotiated Rate	$12,014.47
Max. Negotiated Rate	$12,014.47
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC SF 1ST

Facility

$80,096.45

Service Code	HCPCS 37288
Hospital Charge Code	403437288
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$24,028.94
Rate for Payer: Aetna Medicare Advantage	$24,028.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,424.59
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,412.54
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC EVSC TPVT ATHRC SF 1ST

Facility

$80,096.45

Service Code	HCPCS 37288
Hospital Charge Code	404637288
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$43,654.87
Rate for Payer: Aetna Commercial	$24,028.94
Rate for Payer: Aetna Medicare Advantage	$24,028.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,424.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,424.59
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,412.54
Rate for Payer: Qualcare PPO/HMO/WC	$12,014.47

REVSC IMVT ANGIO SF

Facility

$68,574.00

Service Code	HCPCS 37296
Hospital Charge Code	404637296
Hospital Revenue Code	481
Min. Negotiated Rate	$10,286.10
Max. Negotiated Rate	$10,286.10
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10

REVSC IMVT ANGIO SF

Facility

$68,574.00

Service Code	HCPCS 37296
Hospital Charge Code	404637296
Hospital Revenue Code	481
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$20,572.20
Rate for Payer: Aetna Medicare Advantage	$20,572.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,486.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,486.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,486.37
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,914.62
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10

REV SH CUP BRNG HMRL 40MM3VITE

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270700225
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$3,450.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

REV SH CUP BRNG HMRL 40MM3VITE

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270700225
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

REV SH HD VERSADIAL GL 3 40 MM

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700223
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

REV SH HD VERSADIAL GL 3 40 MM

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700223
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$1,854.00
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

REV SH HUMERAL TRAY NEUTRAL0MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$6,037.50
Rate for Payer: Aetna Commercial	$3,622.50
Rate for Payer: Aetna Medicare Advantage	$3,622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,079.12
Rate for Payer: Cigna Commercial	$6,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

REV SH HUMERAL TRAY NEUTRAL0MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$2,922.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

REWIRE 2 PHONES, 2 DATA, 2 REA

Facility

$1,819.00

Hospital Charge Code	270659145
Hospital Revenue Code	278
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$909.50
Rate for Payer: Aetna Commercial	$545.70
Rate for Payer: Aetna Medicare Advantage	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.85
Rate for Payer: Cigna Commercial	$909.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.20
Rate for Payer: Qualcare PPO/HMO/WC	$272.85

REWIRE 2 PHONES, 2 DATA, 2 REA

Facility

$1,819.00

Hospital Charge Code	270659145
Hospital Revenue Code	278
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$440.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.20
Rate for Payer: Qualcare PPO/HMO/WC	$272.85

REWIRE PHONE LINES AND DATA

Facility

$2,006.25

Hospital Charge Code	270659144
Hospital Revenue Code	278
Min. Negotiated Rate	$300.94
Max. Negotiated Rate	$485.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.51
Rate for Payer: Qualcare PPO/HMO/WC	$300.94

REWIRE PHONE LINES AND DATA

Facility

$2,006.25

Hospital Charge Code	270659144
Hospital Revenue Code	278
Min. Negotiated Rate	$300.94
Max. Negotiated Rate	$1,003.12
Rate for Payer: Aetna Commercial	$601.88
Rate for Payer: Aetna Medicare Advantage	$601.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.59
Rate for Payer: Cigna Commercial	$1,003.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.51
Rate for Payer: Qualcare PPO/HMO/WC	$300.94

REZULIN 200MG TAB

Facility

$21.00

Hospital Charge Code	60635170
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

REZULIN 200MG TAB

Facility

$21.00

Hospital Charge Code	60635170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

REZULIN 400MG TAB

Facility

$27.00

Hospital Charge Code	60635171
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

Know your out-of-pocket cost for care.

All Charges