Heights University Hospital

All Charges

Charge

Type

Setting

Price

TENDRIL LEADS U PR 52

Facility

$3,000.00

Service Code	HCPCS C1898
Hospital Charge Code	270668443S
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

TENDRILLEADS U PR 52

Facility

$2,000.00

Service Code	HCPCS C1898
Hospital Charge Code	270668443
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

TENDRILLEADS U PR 52

Facility

$2,000.00

Service Code	HCPCS C1898
Hospital Charge Code	270668443
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

TENDRIL LEADS U PR 58

Facility

$4,515.00

Service Code	HCPCS C1898
Hospital Charge Code	270669000N
Hospital Revenue Code	278
Min. Negotiated Rate	$677.25
Max. Negotiated Rate	$1,092.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.63
Rate for Payer: Qualcare PPO/HMO/WC	$677.25

TENDRIL LEADS U PR 58

Facility

$4,515.00

Service Code	HCPCS C1898
Hospital Charge Code	270669000S
Hospital Revenue Code	278
Min. Negotiated Rate	$677.25
Max. Negotiated Rate	$1,092.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.63
Rate for Payer: Qualcare PPO/HMO/WC	$677.25

TENDRIL LEADS U PR 58

Facility

$4,515.00

Service Code	HCPCS C1898
Hospital Charge Code	270669000S
Hospital Revenue Code	278
Min. Negotiated Rate	$677.25
Max. Negotiated Rate	$2,257.50
Rate for Payer: Aetna Commercial	$1,354.50
Rate for Payer: Aetna Medicare Advantage	$1,354.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,151.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,151.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,151.33
Rate for Payer: Cigna Commercial	$2,257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.63
Rate for Payer: Qualcare PPO/HMO/WC	$677.25

TENDRIL LEADS U PR 58

Facility

$4,515.00

Service Code	HCPCS C1898
Hospital Charge Code	270669000N
Hospital Revenue Code	278
Min. Negotiated Rate	$677.25
Max. Negotiated Rate	$2,257.50
Rate for Payer: Aetna Commercial	$1,354.50
Rate for Payer: Aetna Medicare Advantage	$1,354.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,151.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,151.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,151.33
Rate for Payer: Cigna Commercial	$2,257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,092.63
Rate for Payer: Qualcare PPO/HMO/WC	$677.25

Tenecteplase 50mg inj

Facility

$28,404.46

Hospital Charge Code	606361032
Hospital Revenue Code	636
Min. Negotiated Rate	$4,260.67
Max. Negotiated Rate	$14,202.23
Rate for Payer: Aetna Commercial	$8,521.34
Rate for Payer: Aetna Medicare Advantage	$8,521.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,243.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,243.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,243.14
Rate for Payer: Cigna Commercial	$14,202.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,873.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,260.67

Tenecteplase 50mg inj

Facility

$28,404.46

Hospital Charge Code	606361032
Hospital Revenue Code	636
Min. Negotiated Rate	$4,260.67
Max. Negotiated Rate	$6,873.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,873.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,260.67

TEN FUSE PIP ALLOGRAFT 2.0 X 1

Facility

$5,625.00

Hospital Charge Code	270665477
Hospital Revenue Code	270
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$731.25
Rate for Payer: Oxford Commercial	$2,812.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Commercial	$2,812.50

TEN FUSE PIP ALLOGRAFT 2.0 X 1

Facility

$5,625.00

Hospital Charge Code	270665477
Hospital Revenue Code	270
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

TENIVAC 0.5ML PREFILLED SYRING

Facility

$192.76

Service Code	HCPCS 90714
Hospital Charge Code	606350971
Hospital Revenue Code	636
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Commercial	$57.83
Rate for Payer: Aetna Medicare Advantage	$57.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.15
Rate for Payer: Cigna Commercial	$38.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.91

TENIVAC 0.5ML PREFILLED SYRING

Facility

$192.76

Service Code	HCPCS 90714
Hospital Charge Code	606350971
Hospital Revenue Code	636
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$46.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.91

TENIVAC EX

Facility

$192.76

Service Code	NDC 49281021515
Hospital Charge Code	606350971X
Hospital Revenue Code	259
Min. Negotiated Rate	$25.06
Max. Negotiated Rate	$96.38
Rate for Payer: Aetna Commercial	$57.83
Rate for Payer: Aetna Medicare Advantage	$57.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.15
Rate for Payer: Cigna Commercial	$96.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.06
Rate for Payer: Oxford Commercial	$96.38
Rate for Payer: Qualcare PPO/HMO/WC	$28.91
Rate for Payer: UnitedHealthcare Commercial	$96.38

TENIVAC EX

Facility

$192.76

Service Code	NDC 49281021515
Hospital Charge Code	606350971X
Hospital Revenue Code	259
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$28.91
Rate for Payer: Qualcare PPO/HMO/WC	$28.91

TENJET PERCUTANOUS SYSTEM

Facility

$4,250.00

Hospital Charge Code	270691836
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

TENJET PERCUTANOUS SYSTEM

Facility

$4,250.00

Hospital Charge Code	270691836
Hospital Revenue Code	272
Min. Negotiated Rate	$552.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.50
Rate for Payer: Oxford Commercial	$2,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Commercial	$2,125.00

TEN-K/10MEQ/TAB

Facility

$3.00

Hospital Charge Code	60633983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

TEN-K/10MEQ/TAB

Facility

$3.00

Hospital Charge Code	60633983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TENLYSIS FL/EX TEND FA/W EA TN

Facility

$19,467.90

Service Code	HCPCS 25295
Hospital Charge Code	16000505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

TENLYSIS FL/EX TEND FA/W EA TN

Facility

$19,467.90

Service Code	HCPCS 25295
Hospital Charge Code	16000505
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$5,840.37
Rate for Payer: Aetna Medicare Advantage	$5,840.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,964.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,964.31
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	$4,964.31
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,530.83
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TENODESIS BIO 7x23mm AR1570B

Facility

$1,463.25

Hospital Charge Code	270633796
Hospital Revenue Code	278
Min. Negotiated Rate	$219.49
Max. Negotiated Rate	$731.62
Rate for Payer: Aetna Commercial	$438.98
Rate for Payer: Aetna Medicare Advantage	$438.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.13
Rate for Payer: Cigna Commercial	$731.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.11
Rate for Payer: Qualcare PPO/HMO/WC	$219.49

TENODESIS BIO 7x23mm AR1570B

Facility

$1,463.25

Hospital Charge Code	270633796
Hospital Revenue Code	278
Min. Negotiated Rate	$219.49
Max. Negotiated Rate	$354.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.11
Rate for Payer: Qualcare PPO/HMO/WC	$219.49

TENODESIS GRAFT SIZING KIT

Facility

$1,475.00

Hospital Charge Code	270694886
Hospital Revenue Code	279
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

TENODESIS GRAFT SIZING KIT

Facility

$1,475.00

Hospital Charge Code	270694886
Hospital Revenue Code	279
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

Know your out-of-pocket cost for care.

All Charges