Heights University Hospital

All Charges

Charge

Type

Setting

Price

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$9,031.50
Max. Negotiated Rate	$30,105.00
Rate for Payer: Aetna Commercial	$18,063.00
Rate for Payer: Aetna Medicare Advantage	$18,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,353.55
Rate for Payer: Cigna Commercial	$30,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50

SEGMENT MDT BIF 28 16 X2816165

Facility

$39,984.85

Hospital Charge Code	270629596
Hospital Revenue Code	278
Min. Negotiated Rate	$5,997.73
Max. Negotiated Rate	$19,992.42
Rate for Payer: Aetna Commercial	$11,995.45
Rate for Payer: Aetna Medicare Advantage	$11,995.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,196.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,196.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,996.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,196.14
Rate for Payer: Cigna Commercial	$19,992.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,676.33
Rate for Payer: Qualcare PPO/HMO/WC	$5,997.73

SEGMENT MDT BIF 28 16 X2816165

Facility

$39,984.85

Hospital Charge Code	270629596
Hospital Revenue Code	278
Min. Negotiated Rate	$5,997.73
Max. Negotiated Rate	$9,676.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,996.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,676.33
Rate for Payer: Qualcare PPO/HMO/WC	$5,997.73

SEGMENT MDT FEM ILIAC R2414165

Facility

$37,750.00

Hospital Charge Code	270623298
Hospital Revenue Code	278
Min. Negotiated Rate	$5,662.50
Max. Negotiated Rate	$18,875.00
Rate for Payer: Aetna Commercial	$11,325.00
Rate for Payer: Aetna Medicare Advantage	$11,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,626.25
Rate for Payer: Cigna Commercial	$18,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50

SEGMENT MDT FEM ILIAC R2414165

Facility

$37,750.00

Hospital Charge Code	270623298
Hospital Revenue Code	278
Min. Negotiated Rate	$5,662.50
Max. Negotiated Rate	$9,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50

SEGMENTS BI 26x15 YRBRX2615165

Facility

$37,448.00

Hospital Charge Code	270631397
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$18,724.00
Rate for Payer: Aetna Commercial	$11,234.40
Rate for Payer: Aetna Medicare Advantage	$11,234.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,549.24
Rate for Payer: Cigna Commercial	$18,724.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEGMENTS BI 26x15 YRBRX2615165

Facility

$37,448.00

Hospital Charge Code	270631397
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$9,062.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEGMENTS BIFURCATED 28X16X135

Facility

$37,448.00

Hospital Charge Code	270631577
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$18,724.00
Rate for Payer: Aetna Commercial	$11,234.40
Rate for Payer: Aetna Medicare Advantage	$11,234.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,549.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,549.24
Rate for Payer: Cigna Commercial	$18,724.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEGMENTS BIFURCATED 28X16X135

Facility

$37,448.00

Hospital Charge Code	270631577
Hospital Revenue Code	278
Min. Negotiated Rate	$5,617.20
Max. Negotiated Rate	$9,062.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,489.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,062.42
Rate for Payer: Qualcare PPO/HMO/WC	$5,617.20

SEIZURE

Facility

$26,042.85

Service Code	APR-DRG 0534
Min. Negotiated Rate	$22,685.55
Max. Negotiated Rate	$26,042.85
Rate for Payer: Aetna Better Health Medicaid	$25,532.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,042.85
Rate for Payer: Wellpoint Medicaid Managed Care	$22,685.55

SEIZURE

Facility

$6,513.50

Service Code	APR-DRG 0531
Min. Negotiated Rate	$5,077.25
Max. Negotiated Rate	$6,513.50
Rate for Payer: Aetna Better Health Medicaid	$6,385.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,513.50
Rate for Payer: Wellpoint Medicaid Managed Care	$5,077.25

SEIZURE

Facility

$8,468.44

Service Code	APR-DRG 0532
Min. Negotiated Rate	$6,027.19
Max. Negotiated Rate	$8,468.44
Rate for Payer: Aetna Better Health Medicaid	$8,302.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,468.44
Rate for Payer: Wellpoint Medicaid Managed Care	$6,027.19

SEIZURE

Facility

$11,566.49

Service Code	APR-DRG 0533
Min. Negotiated Rate	$9,013.32
Max. Negotiated Rate	$11,566.49
Rate for Payer: Aetna Better Health Medicaid	$11,339.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,566.49
Rate for Payer: Wellpoint Medicaid Managed Care	$9,013.32

SEIZURES WITH MCC

Facility

$68,039.28

Service Code	MSDRG 100
Min. Negotiated Rate	$21,135.49
Max. Negotiated Rate	$68,039.28
Rate for Payer: Aetna Commercial	$65,308.66
Rate for Payer: Aetna Medicare Advantage	$21,135.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,582.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,582.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,679.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,582.66
Rate for Payer: Cigna Commercial	$41,681.87
Rate for Payer: Cigna Medicare Advantage	$22,679.76
Rate for Payer: Clover Medicare Advantage	$21,545.77
Rate for Payer: EmblemHealth Commercial	$68,039.28
Rate for Payer: Humana Medicare Advantage	$23,360.15
Rate for Payer: Oxford Commercial	$26,049.96
Rate for Payer: UnitedHealthcare Commercial	$29,569.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,679.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$24,040.55
Rate for Payer: Wellcare Medicare Advantage	$22,679.76

SEIZURES WITHOUT MCC

Facility

$38,020.86

Service Code	MSDRG 101
Min. Negotiated Rate	$9,849.70
Max. Negotiated Rate	$38,020.86
Rate for Payer: Aetna Commercial	$30,435.57
Rate for Payer: Aetna Medicare Advantage	$9,849.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,085.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,085.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,673.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,085.97
Rate for Payer: Cigna Commercial	$19,424.85
Rate for Payer: Cigna Medicare Advantage	$12,673.62
Rate for Payer: Clover Medicare Advantage	$12,039.94
Rate for Payer: EmblemHealth Commercial	$38,020.86
Rate for Payer: Humana Medicare Advantage	$13,053.83
Rate for Payer: Oxford Commercial	$12,139.97
Rate for Payer: UnitedHealthcare Commercial	$13,779.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,673.62
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13,434.04
Rate for Payer: Wellcare Medicare Advantage	$12,673.62

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	366836015R
Hospital Revenue Code	361
Min. Negotiated Rate	$46.67
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$107.70
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	411036015
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	411036015
Hospital Revenue Code	361
Min. Negotiated Rate	$46.67
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$107.70
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	366836015R
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SELDANE/60MG/TAB

Facility

$6.00

Hospital Charge Code	60633858
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SELDANE/60MG/TAB

Facility

$6.00

Hospital Charge Code	60633858
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SELEGILINE 5 MG TAB

Facility

$15.41

Service Code	NDC 60505005501
Hospital Charge Code	6027064
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.71
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.71

SELEGILINE 5 MG TAB

Facility

$15.41

Service Code	NDC 60505005501
Hospital Charge Code	6027064
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

SELEGILINE 6 MG/24 HR PATCH

Facility

$110.05

Hospital Charge Code	60629953
Hospital Revenue Code	250
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$55.02
Rate for Payer: Aetna Commercial	$33.02
Rate for Payer: Aetna Medicare Advantage	$33.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.06
Rate for Payer: Cigna Commercial	$55.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.31
Rate for Payer: Oxford Commercial	$55.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.51
Rate for Payer: UnitedHealthcare Commercial	$55.02

SELEGILINE 6 MG/24 HR PATCH

Facility

$110.05

Hospital Charge Code	60629953
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$16.51
Rate for Payer: Qualcare PPO/HMO/WC	$16.51

Know your out-of-pocket cost for care.

All Charges