Heights University Hospital

All Charges

Charge

Type

Setting

Price

ST EVALUATION OF SPEECH FLUENC

Facility

$2,400.00

Service Code	HCPCS 92521GN
Hospital Charge Code	74204039
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

STE VIA 7FR 15X120cm VBH061502

Facility

$18,350.00

Hospital Charge Code	270639498C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.50
Max. Negotiated Rate	$4,440.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50

STE VIA 7FR 15X120cm VBH061502

Facility

$18,350.00

Hospital Charge Code	270639498C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.50
Max. Negotiated Rate	$9,175.00
Rate for Payer: Aetna Commercial	$5,505.00
Rate for Payer: Aetna Medicare Advantage	$5,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,679.25
Rate for Payer: Cigna Commercial	$9,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50

STH PINCLE 7F 65 RSP02

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642217N
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$292.82
Rate for Payer: Aetna Commercial	$175.69
Rate for Payer: Aetna Medicare Advantage	$175.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.34
Rate for Payer: Cigna Commercial	$292.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: Qualcare PPO/HMO/WC	$87.85

STH PINCLE 7F 65 RSP02

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642217N
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$141.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: Qualcare PPO/HMO/WC	$87.85

STH PINCLE 7F 65 RSP02

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642217C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$174.00
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

STH PINCLE 7F 65 RSP02

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642217C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

STICK DRESSING THER. A698-5

Facility

$24.85

Hospital Charge Code	270613432
Hospital Revenue Code	279
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$7.46
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$12.43

STICK DRESSING THER. A698-5

Facility

$24.85

Hospital Charge Code	270613432
Hospital Revenue Code	279
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

STICK MINI 4FR 7CM

Facility

$85.00

Hospital Charge Code	270665911
Hospital Revenue Code	270
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

STICK MINI 4FR 7CM

Facility

$85.00

Hospital Charge Code	270665911
Hospital Revenue Code	270
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$25.50
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$42.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$42.50

STICK QUICK ICP MONITR 0295002

Facility

$422.45

Hospital Charge Code	270600152
Hospital Revenue Code	270
Min. Negotiated Rate	$54.92
Max. Negotiated Rate	$211.22
Rate for Payer: Aetna Commercial	$126.73
Rate for Payer: Aetna Medicare Advantage	$126.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.72
Rate for Payer: Cigna Commercial	$211.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.92
Rate for Payer: Oxford Commercial	$211.22
Rate for Payer: Qualcare PPO/HMO/WC	$63.37
Rate for Payer: UnitedHealthcare Commercial	$211.22

STICK QUICK ICP MONITR 0295002

Facility

$422.45

Hospital Charge Code	270600152
Hospital Revenue Code	270
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$63.37
Rate for Payer: Qualcare PPO/HMO/WC	$63.37

STIFF CRESCENT MEDIUM

Facility

$65.75

Hospital Charge Code	270665798
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$32.88
Rate for Payer: Aetna Commercial	$19.73
Rate for Payer: Aetna Medicare Advantage	$19.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.77
Rate for Payer: Cigna Commercial	$32.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$32.88
Rate for Payer: Qualcare PPO/HMO/WC	$9.86
Rate for Payer: UnitedHealthcare Commercial	$32.88

STIFF CRESCENT MEDIUM

Facility

$65.75

Hospital Charge Code	270665798
Hospital Revenue Code	270
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$9.86
Rate for Payer: Qualcare PPO/HMO/WC	$9.86

STIFF HEXAGONAL MEDIUM

Facility

$65.75

Hospital Charge Code	270665797
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$32.88
Rate for Payer: Aetna Commercial	$19.73
Rate for Payer: Aetna Medicare Advantage	$19.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.77
Rate for Payer: Cigna Commercial	$32.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$32.88
Rate for Payer: Qualcare PPO/HMO/WC	$9.86
Rate for Payer: UnitedHealthcare Commercial	$32.88

STIFF HEXAGONAL MEDIUM

Facility

$65.75

Hospital Charge Code	270665797
Hospital Revenue Code	272
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$9.86
Rate for Payer: Qualcare PPO/HMO/WC	$9.86

STIFFNECK SELECT

Facility

$39.55

Hospital Charge Code	270653986
Hospital Revenue Code	270
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$11.87
Rate for Payer: Aetna Medicare Advantage	$11.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.09
Rate for Payer: Cigna Commercial	$19.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$19.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.93
Rate for Payer: UnitedHealthcare Commercial	$19.77

STIFFNECK SELECT

Facility

$39.55

Hospital Charge Code	270653986
Hospital Revenue Code	270
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.93

STIFF OVAL MEDIUM

Facility

$68.50

Hospital Charge Code	270665796
Hospital Revenue Code	272
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$34.25
Rate for Payer: Aetna Commercial	$20.55
Rate for Payer: Aetna Medicare Advantage	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.47
Rate for Payer: Cigna Commercial	$34.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.90
Rate for Payer: Oxford Commercial	$34.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.28
Rate for Payer: UnitedHealthcare Commercial	$34.25

STIFF OVAL MEDIUM

Facility

$68.50

Hospital Charge Code	270665796
Hospital Revenue Code	272
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$10.28
Rate for Payer: Qualcare PPO/HMO/WC	$10.28

STIFF OVAL SMALL

Facility

$68.50

Hospital Charge Code	270665795
Hospital Revenue Code	272
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$34.25
Rate for Payer: Aetna Commercial	$20.55
Rate for Payer: Aetna Medicare Advantage	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.47
Rate for Payer: Cigna Commercial	$34.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.90
Rate for Payer: Oxford Commercial	$34.25
Rate for Payer: Qualcare PPO/HMO/WC	$10.28
Rate for Payer: UnitedHealthcare Commercial	$34.25

STIFF OVAL SMALL

Facility

$68.50

Hospital Charge Code	270665795
Hospital Revenue Code	272
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$10.28
Rate for Payer: Qualcare PPO/HMO/WC	$10.28

STIFF ROUND EXTRA LARGE

Facility

$75.80

Hospital Charge Code	270665799
Hospital Revenue Code	272
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$37.90
Rate for Payer: Aetna Commercial	$22.74
Rate for Payer: Aetna Medicare Advantage	$22.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.33
Rate for Payer: Cigna Commercial	$37.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.85
Rate for Payer: Oxford Commercial	$37.90
Rate for Payer: Qualcare PPO/HMO/WC	$11.37
Rate for Payer: UnitedHealthcare Commercial	$37.90

STIFF ROUND EXTRA LARGE

Facility

$75.80

Hospital Charge Code	270665799
Hospital Revenue Code	272
Min. Negotiated Rate	$11.37
Max. Negotiated Rate	$11.37
Rate for Payer: Qualcare PPO/HMO/WC	$11.37

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