Heights University Hospital

All Charges

Charge

Type

Setting

Price

THROMBECTOMY SET SPIROFLEX

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX UL

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX UL

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX ULT

Facility

$10,350.00

Hospital Charge Code	2709006399
Hospital Revenue Code	272
Min. Negotiated Rate	$1,345.50
Max. Negotiated Rate	$5,175.00
Rate for Payer: Aetna Commercial	$3,105.00
Rate for Payer: Aetna Medicare Advantage	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,639.25
Rate for Payer: Cigna Commercial	$5,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,345.50
Rate for Payer: Oxford Commercial	$5,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50
Rate for Payer: UnitedHealthcare Commercial	$5,175.00

THROMBECTOMY SET SPIROFLEX ULT

Facility

$10,350.00

Hospital Charge Code	2709006399
Hospital Revenue Code	272
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$1,552.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

THROMBIN (BOVINE) 5000 U VIAL

Facility

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$75.01
Max. Negotiated Rate	$288.50
Rate for Payer: Aetna Commercial	$173.10
Rate for Payer: Aetna Medicare Advantage	$173.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.13
Rate for Payer: Cigna Commercial	$288.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.01
Rate for Payer: Oxford Commercial	$288.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.55
Rate for Payer: UnitedHealthcare Commercial	$288.50

THROMBIN (BOVINE) 5000 U VIAL

Facility

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$86.55
Max. Negotiated Rate	$86.55
Rate for Payer: Qualcare PPO/HMO/WC	$86.55

THROMBIN BOVINE TOPICAL 10,000

Facility

$106.90

Hospital Charge Code	6013270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$53.45
Rate for Payer: Aetna Commercial	$32.07
Rate for Payer: Aetna Medicare Advantage	$32.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.26
Rate for Payer: Cigna Commercial	$53.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Oxford Commercial	$53.45
Rate for Payer: Qualcare PPO/HMO/WC	$16.04
Rate for Payer: UnitedHealthcare Commercial	$53.45

THROMBIN BOVINE TOPICAL 10,000

Facility

$106.90

Hospital Charge Code	6013270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

THROMBIN CLOTTING TIME

Facility

$63.25

Service Code	HCPCS 85670
Hospital Charge Code	3007820
Hospital Revenue Code	305
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

THROMBIN CLOTTING TIME

Facility

$63.25

Service Code	HCPCS 85670
Hospital Charge Code	3007820
Hospital Revenue Code	305
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.14
Rate for Payer: Cigna Commercial	$5.77
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.12
Rate for Payer: Wellcare Medicare Advantage	$5.77

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.14
Rate for Payer: Cigna Commercial	$5.77
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.12
Rate for Payer: Wellcare Medicare Advantage	$5.77

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$88.29
Max. Negotiated Rate	$88.29
Rate for Payer: Qualcare PPO/HMO/WC	$88.29

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$76.52
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna Commercial	$176.58
Rate for Payer: Aetna Medicare Advantage	$176.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.09
Rate for Payer: Cigna Commercial	$294.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.52
Rate for Payer: Oxford Commercial	$294.30
Rate for Payer: Qualcare PPO/HMO/WC	$88.29
Rate for Payer: UnitedHealthcare Commercial	$294.30

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$359.55
Max. Negotiated Rate	$1,382.88
Rate for Payer: Aetna Commercial	$829.73
Rate for Payer: Aetna Medicare Advantage	$829.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$705.27
Rate for Payer: Cigna Commercial	$1,382.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.55
Rate for Payer: Oxford Commercial	$1,382.88
Rate for Payer: Qualcare PPO/HMO/WC	$414.86
Rate for Payer: UnitedHealthcare Commercial	$1,382.88

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$414.86
Max. Negotiated Rate	$414.86
Rate for Payer: Qualcare PPO/HMO/WC	$414.86

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.14
Rate for Payer: Cigna Commercial	$5.77
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.12
Rate for Payer: Wellcare Medicare Advantage	$5.77

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.14
Rate for Payer: Cigna Commercial	$5.77
Rate for Payer: Cigna Medicare Advantage	$2.88
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.12
Rate for Payer: Wellcare Medicare Advantage	$5.77

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

THROMBIN TOPICAL 5000U

Facility

$176.00

Hospital Charge Code	60635488
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$26.40
Rate for Payer: Qualcare PPO/HMO/WC	$26.40

THROMBIN TOPICAL 5000U

Facility

$176.00

Hospital Charge Code	60635488
Hospital Revenue Code	250
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna Commercial	$52.80
Rate for Payer: Aetna Medicare Advantage	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.88
Rate for Payer: Cigna Commercial	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.40
Rate for Payer: UnitedHealthcare Commercial	$88.00

THROMBIN TOPICAL KIT 10,000U

Facility

$343.70

Hospital Charge Code	60627529
Hospital Revenue Code	250
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$51.55
Rate for Payer: Qualcare PPO/HMO/WC	$51.55

Know your out-of-pocket cost for care.

All Charges