Heights University Hospital

All Charges

Charge

Type

Setting

Price

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
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

SET TRACHEOESOPHAGEAL PUNCTURE

Facility

$1,179.00

Hospital Charge Code	270645551
Hospital Revenue Code	272
Min. Negotiated Rate	$176.85
Max. Negotiated Rate	$176.85
Rate for Payer: Qualcare PPO/HMO/WC	$176.85

SET TRACHEOESOPHAGEAL PUNCTURE

Facility

$1,179.00

Hospital Charge Code	270645551
Hospital Revenue Code	272
Min. Negotiated Rate	$153.27
Max. Negotiated Rate	$589.50
Rate for Payer: Aetna Commercial	$353.70
Rate for Payer: Aetna Medicare Advantage	$353.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.64
Rate for Payer: Cigna Commercial	$589.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.27
Rate for Payer: Oxford Commercial	$589.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.85
Rate for Payer: UnitedHealthcare Commercial	$589.50

SET TROCAR FTBAL RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270614364
Hospital Revenue Code	272
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$134.43
Rate for Payer: Aetna Commercial	$80.66
Rate for Payer: Aetna Medicare Advantage	$80.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.56
Rate for Payer: Cigna Commercial	$134.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.95
Rate for Payer: Oxford Commercial	$134.43
Rate for Payer: Qualcare PPO/HMO/WC	$40.33
Rate for Payer: UnitedHealthcare Commercial	$134.43

SET TROCAR FTBAL RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270614364
Hospital Revenue Code	272
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$40.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.33

SET TROCAR RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270613419
Hospital Revenue Code	272
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$40.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.33

SET TROCAR RAULERSON RTT

Facility

$268.85

Hospital Charge Code	270613419
Hospital Revenue Code	272
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$134.43
Rate for Payer: Aetna Commercial	$80.66
Rate for Payer: Aetna Medicare Advantage	$80.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.56
Rate for Payer: Cigna Commercial	$134.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.95
Rate for Payer: Oxford Commercial	$134.43
Rate for Payer: Qualcare PPO/HMO/WC	$40.33
Rate for Payer: UnitedHealthcare Commercial	$134.43

SET TUBE INTERMEDULLARY 281103

Facility

$83.50

Hospital Charge Code	270638602
Hospital Revenue Code	272
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$12.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.53

SET TUBE INTERMEDULLARY 281103

Facility

$83.50

Hospital Charge Code	270638602
Hospital Revenue Code	272
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$41.75
Rate for Payer: Aetna Commercial	$25.05
Rate for Payer: Aetna Medicare Advantage	$25.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.29
Rate for Payer: Cigna Commercial	$41.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.86
Rate for Payer: Oxford Commercial	$41.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.53
Rate for Payer: UnitedHealthcare Commercial	$41.75

SET TUBING IRRIGATION 284504

Facility

$231.25

Hospital Charge Code	270638603
Hospital Revenue Code	272
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

SET TUBING IRRIGATION 284504

Facility

$231.25

Hospital Charge Code	270638603
Hospital Revenue Code	272
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$115.62
Rate for Payer: Aetna Commercial	$69.38
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$115.62
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$115.62

SET TUBING PUMP INFUSION

Facility

$1,196.00

Hospital Charge Code	270651983
Hospital Revenue Code	271
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

SET TUBING PUMP INFUSION

Facility

$1,196.00

Hospital Charge Code	270651983
Hospital Revenue Code	271
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$358.80
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.48
Rate for Payer: Oxford Commercial	$598.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$598.00

SETUP SUTURE

Facility

$289.65

Hospital Charge Code	8500027
Hospital Revenue Code	272
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$86.89
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.65
Rate for Payer: Oxford Commercial	$144.82
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Commercial	$144.82

SETUP SUTURE

Facility

$289.65

Hospital Charge Code	8500027
Hospital Revenue Code	272
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$43.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

SETUP TPA*****

Facility

$220.00

Hospital Charge Code	8003600
Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

SETUP TPA*****

Facility

$220.00

Hospital Charge Code	8003600
Hospital Revenue Code	272
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$110.00

SET VAGINAL IRRIGATION

Facility

$11.25

Hospital Charge Code	270301940
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

SET VAGINAL IRRIGATION

Facility

$11.25

Hospital Charge Code	270301940
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.78
Rate for Payer: Oxford Commercial	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Commercial	$10.69

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SEVELAMER 403MG CAPSULE

Facility

$5.00

Service Code	HCPCS J8499
Hospital Charge Code	60629242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

SEVELAMER 403MG CAPSULE

Facility

$5.00

Service Code	HCPCS J8499
Hospital Charge Code	60629242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SEVOFLURANE INH. BTL

Facility

$1,094.00

Hospital Charge Code	60635672
Hospital Revenue Code	250
Min. Negotiated Rate	$142.22
Max. Negotiated Rate	$547.00
Rate for Payer: Aetna Commercial	$328.20
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$547.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Oxford Commercial	$547.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.10
Rate for Payer: UnitedHealthcare Commercial	$547.00

SEVOFLURANE INH. BTL

Facility

$1,094.00

Hospital Charge Code	60635672
Hospital Revenue Code	250
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

Know your out-of-pocket cost for care.

All Charges