Heights University Hospital

All Charges

Charge

Type

Setting

Price

THEOPHYLLINE TAB 100MG IR

Facility

$3.20

Hospital Charge Code	60628472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

THEOPHYLLINE TAB 100MG IR

Facility

$3.20

Hospital Charge Code	60628472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

THEOPHYLLINE TAB SR 100MG*****

Facility

$6.00

Service Code	HCPCS J8499
Hospital Charge Code	60628474
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

THEOPHYLLINE TAB SR 100MG*****

Facility

$6.00

Service Code	HCPCS J8499
Hospital Charge Code	60628474
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

THEOPHYLLINE TAB SR 400MG

Facility

$7.70

Hospital Charge Code	60628719
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

THEOPHYLLINE TAB SR 400MG

Facility

$7.70

Hospital Charge Code	60628719
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

THEOPHYLLINE TAB SR 600MG

Facility

$8.35

Hospital Charge Code	60628720
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.09
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$4.17

THEOPHYLLINE TAB SR 600MG

Facility

$8.35

Hospital Charge Code	60628720
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

THERABAND BLUE EXTRA HEAVY

Facility

$608.85

Hospital Charge Code	270609834
Hospital Revenue Code	270
Min. Negotiated Rate	$79.15
Max. Negotiated Rate	$304.43
Rate for Payer: Aetna Commercial	$182.66
Rate for Payer: Aetna Medicare Advantage	$182.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.26
Rate for Payer: Cigna Commercial	$304.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.15
Rate for Payer: Oxford Commercial	$304.43
Rate for Payer: Qualcare PPO/HMO/WC	$91.33
Rate for Payer: UnitedHealthcare Commercial	$304.43

THERABAND BLUE EXTRA HEAVY

Facility

$608.85

Hospital Charge Code	270609834
Hospital Revenue Code	270
Min. Negotiated Rate	$91.33
Max. Negotiated Rate	$91.33
Rate for Payer: Qualcare PPO/HMO/WC	$91.33

THERABAND GREEN HEAVY A521-3

Facility

$571.25

Hospital Charge Code	270608153
Hospital Revenue Code	270
Min. Negotiated Rate	$74.26
Max. Negotiated Rate	$285.62
Rate for Payer: Aetna Commercial	$171.38
Rate for Payer: Aetna Medicare Advantage	$171.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.67
Rate for Payer: Cigna Commercial	$285.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.26
Rate for Payer: Oxford Commercial	$285.62
Rate for Payer: Qualcare PPO/HMO/WC	$85.69
Rate for Payer: UnitedHealthcare Commercial	$285.62

THERABAND GREEN HEAVY A521-3

Facility

$571.25

Hospital Charge Code	270608153
Hospital Revenue Code	270
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Qualcare PPO/HMO/WC	$85.69

THERABAND RED 50YD ROLL A521-2

Facility

$405.65

Hospital Charge Code	270612322
Hospital Revenue Code	270
Min. Negotiated Rate	$60.85
Max. Negotiated Rate	$60.85
Rate for Payer: Qualcare PPO/HMO/WC	$60.85

THERABAND RED 50YD ROLL A521-2

Facility

$405.65

Hospital Charge Code	270612322
Hospital Revenue Code	270
Min. Negotiated Rate	$52.73
Max. Negotiated Rate	$202.82
Rate for Payer: Aetna Commercial	$121.69
Rate for Payer: Aetna Medicare Advantage	$121.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.44
Rate for Payer: Cigna Commercial	$202.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.73
Rate for Payer: Oxford Commercial	$202.82
Rate for Payer: Qualcare PPO/HMO/WC	$60.85
Rate for Payer: UnitedHealthcare Commercial	$202.82

THERABAND RED MEDIUM A521-2

Facility

$540.00

Hospital Charge Code	270608154
Hospital Revenue Code	270
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

THERABAND RED MEDIUM A521-2

Facility

$540.00

Hospital Charge Code	270608154
Hospital Revenue Code	270
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Commercial	$270.00

THERABAND YELLOW THIN A521-1

Facility

$500.85

Hospital Charge Code	270609831
Hospital Revenue Code	270
Min. Negotiated Rate	$75.13
Max. Negotiated Rate	$75.13
Rate for Payer: Qualcare PPO/HMO/WC	$75.13

THERABAND YELLOW THIN A521-1

Facility

$500.85

Hospital Charge Code	270609831
Hospital Revenue Code	270
Min. Negotiated Rate	$65.11
Max. Negotiated Rate	$250.43
Rate for Payer: Aetna Commercial	$150.25
Rate for Payer: Aetna Medicare Advantage	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.72
Rate for Payer: Cigna Commercial	$250.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.11
Rate for Payer: Oxford Commercial	$250.43
Rate for Payer: Qualcare PPO/HMO/WC	$75.13
Rate for Payer: UnitedHealthcare Commercial	$250.43

THER ACTIVITY & TRAINING 1/4 H

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008210
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

THER ACTIVITY & TRAINING 1/4 H

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008210
Hospital Revenue Code	430
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$130.20
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.42
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAGENEMESHBILAMATRIX82X60MM

Facility

$11,000.00

Service Code	HCPCS A2008
Hospital Charge Code	270694227
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$3,300.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

THERAGENEMESHBILAMATRIX82X60MM

Facility

$11,000.00

Service Code	HCPCS A2008
Hospital Charge Code	270694227
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

THERAGENESISBILAMATRIX82X120MM

Facility

$12,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270694313
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

THERAGENESISBILAMATRIX82X120MM

Facility

$12,500.00

Service Code	HCPCS A2008
Hospital Charge Code	270694313
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$3,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

THERAGENESISBILAYMATRIX40X60MM

Facility

$7,750.00

Service Code	HCPCS A2008
Hospital Charge Code	270694307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

Know your out-of-pocket cost for care.

All Charges