Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW VARIVAX (VARICELA) VIAL

Facility

$185.00

Service Code	HCPCS 90716
Hospital Charge Code	84206205
Hospital Revenue Code	636
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$44.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

RW VARIVAX (VARICELA) VIAL

Facility

$185.00

Service Code	HCPCS 90716
Hospital Charge Code	84206205
Hospital Revenue Code	636
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$95.20
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

RW VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	87502885
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.22
Rate for Payer: Cigna Commercial	$9.34
Rate for Payer: Cigna Medicare Advantage	$4.67
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.90
Rate for Payer: Wellcare Medicare Advantage	$9.34

RW VENIPUNCTURE

Facility

$390.00

Service Code	HCPCS 36415
Hospital Charge Code	84206095
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502335
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

RW VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	87502885
Hospital Revenue Code	300
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

RW VENIPUNCTURE

Facility

$390.00

Service Code	HCPCS 36415
Hospital Charge Code	84206095
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.22
Rate for Payer: Cigna Commercial	$9.34
Rate for Payer: Cigna Medicare Advantage	$4.67
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.90
Rate for Payer: Wellcare Medicare Advantage	$9.34

RW VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	87502335
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.22
Rate for Payer: Cigna Commercial	$9.34
Rate for Payer: Cigna Medicare Advantage	$4.67
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.90
Rate for Payer: Wellcare Medicare Advantage	$9.34

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	87502001
Hospital Revenue Code	920
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	84206305
Hospital Revenue Code	920
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	87502001
Hospital Revenue Code	920
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RW VISION TEST

Facility

$59.00

Service Code	HCPCS 99173
Hospital Charge Code	84206305
Hospital Revenue Code	920
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

RW ZOSTER (SHINGLES) VAC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	87502855
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RW ZOSTER (SHINGLES) VAC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	87502855
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RW ZOSTER (SHINGLES) VACC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	84206215
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RW ZOSTER (SHINGLES) VACC

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	84206215
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$2,474.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,067.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

RYNATAN PEDIATRIC/480ML

Facility

$280.00

Hospital Charge Code	60633852
Hospital Revenue Code	250
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

RYNATAN PEDIATRIC/480ML

Facility

$280.00

Hospital Charge Code	60633852
Hospital Revenue Code	250
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$84.00
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$140.00

RYNATAN-S/120ML

Facility

$19.00

Hospital Charge Code	60633853
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

RYNATAN-S/120ML

Facility

$19.00

Hospital Charge Code	60633853
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

RYNATAN/TAB

Facility

$7.00

Hospital Charge Code	60633851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

Know your out-of-pocket cost for care.

All Charges