Heights University Hospital

All Charges

Charge

Type

Setting

Price

RR ICU 2 1/2 TO 3 HOURS

Facility

$1,788.00

Hospital Charge Code	1500149
Hospital Revenue Code	710
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$268.20
Rate for Payer: Qualcare PPO/HMO/WC	$268.20

RR ICU 2 1/2 TO 3 HOURS

Facility

$1,788.00

Hospital Charge Code	1500149
Hospital Revenue Code	710
Min. Negotiated Rate	$232.44
Max. Negotiated Rate	$894.00
Rate for Payer: Aetna Commercial	$536.40
Rate for Payer: Aetna Medicare Advantage	$536.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.94
Rate for Payer: Cigna Commercial	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.44
Rate for Payer: Oxford Commercial	$894.00
Rate for Payer: Qualcare PPO/HMO/WC	$268.20
Rate for Payer: UnitedHealthcare Commercial	$894.00

RR ICU 2 TO 2 1/2 HOURS

Facility

$1,609.65

Hospital Charge Code	1500131
Hospital Revenue Code	710
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$804.83
Rate for Payer: Aetna Commercial	$482.89
Rate for Payer: Aetna Medicare Advantage	$482.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.46
Rate for Payer: Cigna Commercial	$804.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.25
Rate for Payer: Oxford Commercial	$804.83
Rate for Payer: Qualcare PPO/HMO/WC	$241.45
Rate for Payer: UnitedHealthcare Commercial	$804.83

RR ICU 2 TO 2 1/2 HOURS

Facility

$1,609.65

Hospital Charge Code	1500131
Hospital Revenue Code	710
Min. Negotiated Rate	$241.45
Max. Negotiated Rate	$241.45
Rate for Payer: Qualcare PPO/HMO/WC	$241.45

RR ICU 3 1/2 TO 4 HOURS

Facility

$2,146.45

Hospital Charge Code	1500164
Hospital Revenue Code	710
Min. Negotiated Rate	$321.97
Max. Negotiated Rate	$321.97
Rate for Payer: Qualcare PPO/HMO/WC	$321.97

RR ICU 3 1/2 TO 4 HOURS

Facility

$2,146.45

Hospital Charge Code	1500164
Hospital Revenue Code	710
Min. Negotiated Rate	$279.04
Max. Negotiated Rate	$1,073.22
Rate for Payer: Aetna Commercial	$643.93
Rate for Payer: Aetna Medicare Advantage	$643.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$547.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$547.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$547.34
Rate for Payer: Cigna Commercial	$1,073.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.04
Rate for Payer: Oxford Commercial	$1,073.22
Rate for Payer: Qualcare PPO/HMO/WC	$321.97
Rate for Payer: UnitedHealthcare Commercial	$1,073.22

RR ICU 3 TO 3 1/2 HOURS

Facility

$1,967.25

Hospital Charge Code	1500156
Hospital Revenue Code	710
Min. Negotiated Rate	$255.74
Max. Negotiated Rate	$983.62
Rate for Payer: Aetna Commercial	$590.17
Rate for Payer: Aetna Medicare Advantage	$590.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.65
Rate for Payer: Cigna Commercial	$983.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.74
Rate for Payer: Oxford Commercial	$983.62
Rate for Payer: Qualcare PPO/HMO/WC	$295.09
Rate for Payer: UnitedHealthcare Commercial	$983.62

RR ICU 3 TO 3 1/2 HOURS

Facility

$1,967.25

Hospital Charge Code	1500156
Hospital Revenue Code	710
Min. Negotiated Rate	$295.09
Max. Negotiated Rate	$295.09
Rate for Payer: Qualcare PPO/HMO/WC	$295.09

RR ICU EACH ADD'L 1/2 HOUR

Facility

$179.25

Hospital Charge Code	1500172
Hospital Revenue Code	710
Min. Negotiated Rate	$23.30
Max. Negotiated Rate	$89.62
Rate for Payer: Aetna Commercial	$53.77
Rate for Payer: Aetna Medicare Advantage	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.71
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$89.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$89.62

RR ICU EACH ADD'L 1/2 HOUR

Facility

$179.25

Hospital Charge Code	1500172
Hospital Revenue Code	710
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

RR ICU ONE HOUR

Facility

$1,073.65

Hospital Charge Code	1500107
Hospital Revenue Code	710
Min. Negotiated Rate	$139.57
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$322.10
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.57
Rate for Payer: Oxford Commercial	$536.83
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Commercial	$536.83

RR ICU ONE HOUR

Facility

$1,073.65

Hospital Charge Code	1500107
Hospital Revenue Code	710
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$161.05
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

RSI KIT(RAPID SEQ INTUBA)

Facility

$83.00

Hospital Charge Code	60635402
Hospital Revenue Code	250
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$24.90
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$41.50

RSI KIT(RAPID SEQ INTUBA)

Facility

$83.00

Hospital Charge Code	60635402
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

RSS BODY SCREW

Facility

$984.75

Service Code	HCPCS C1713
Hospital Charge Code	270688882
Hospital Revenue Code	278
Min. Negotiated Rate	$147.71
Max. Negotiated Rate	$492.38
Rate for Payer: Aetna Commercial	$295.43
Rate for Payer: Aetna Medicare Advantage	$295.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.11
Rate for Payer: Cigna Commercial	$492.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.31
Rate for Payer: Qualcare PPO/HMO/WC	$147.71

RSS BODY SCREW

Facility

$984.75

Service Code	HCPCS C1713
Hospital Charge Code	270688882
Hospital Revenue Code	278
Min. Negotiated Rate	$147.71
Max. Negotiated Rate	$238.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.31
Rate for Payer: Qualcare PPO/HMO/WC	$147.71

RSS GLENOID BASEPLATE-S

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

RSS GLENOID BASEPLATE-S

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$3,617.25
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

RSS GLENOSPHERE ECCENTRI-S 2MM

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688778
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

RSS GLENOSPHERE ECCENTRI-S 2MM

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688778
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$3,752.78
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

RSS HXL LINER STD 0S

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691335
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$1,928.61
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

RSS HXL LINER STD 0S

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691335
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

RSV VIRUS IMMUNE GLOBULIN

Facility

$462.30

Service Code	NDC 49281057515
Hospital Charge Code	6064943022
Hospital Revenue Code	250
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$231.15
Rate for Payer: Aetna Commercial	$138.69
Rate for Payer: Aetna Medicare Advantage	$138.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.89
Rate for Payer: Cigna Commercial	$231.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.10
Rate for Payer: Oxford Commercial	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$69.34
Rate for Payer: UnitedHealthcare Commercial	$231.15

RSV VIRUS IMMUNE GLOBULIN

Facility

$462.30

Service Code	NDC 49281057515
Hospital Charge Code	6064943022
Hospital Revenue Code	250
Min. Negotiated Rate	$69.34
Max. Negotiated Rate	$69.34
Rate for Payer: Qualcare PPO/HMO/WC	$69.34

RT BASIC DOSIMETRY

Facility

$353.95

Service Code	HCPCS 77300
Hospital Charge Code	4800058
Hospital Revenue Code	333
Min. Negotiated Rate	$53.09
Max. Negotiated Rate	$53.09
Rate for Payer: Qualcare PPO/HMO/WC	$53.09

Know your out-of-pocket cost for care.

All Charges