Heights University Hospital

All Charges

Charge

Type

Setting

Price

THROMBIN TOPICAL KIT 10,000U

Facility

$343.70

Hospital Charge Code	60627529
Hospital Revenue Code	250
Min. Negotiated Rate	$44.68
Max. Negotiated Rate	$171.85
Rate for Payer: Aetna Commercial	$103.11
Rate for Payer: Aetna Medicare Advantage	$103.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.64
Rate for Payer: Cigna Commercial	$171.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.68
Rate for Payer: Oxford Commercial	$171.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.55
Rate for Payer: UnitedHealthcare Commercial	$171.85

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$341.35
Max. Negotiated Rate	$341.35
Rate for Payer: Qualcare PPO/HMO/WC	$341.35

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$295.84
Max. Negotiated Rate	$1,137.83
Rate for Payer: Aetna Commercial	$682.70
Rate for Payer: Aetna Medicare Advantage	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.29
Rate for Payer: Cigna Commercial	$1,137.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.84
Rate for Payer: Oxford Commercial	$1,137.83
Rate for Payer: Qualcare PPO/HMO/WC	$341.35
Rate for Payer: UnitedHealthcare Commercial	$1,137.83

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	366837214
Hospital Revenue Code	361
Min. Negotiated Rate	$864.44
Max. Negotiated Rate	$864.44
Rate for Payer: Qualcare PPO/HMO/WC	$864.44

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	366837214
Hospital Revenue Code	361
Min. Negotiated Rate	$749.18
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,728.88
Rate for Payer: Aetna Medicare Advantage	$1,728.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.55
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	$1,469.55
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.18
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.44
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	411037214
Hospital Revenue Code	361
Min. Negotiated Rate	$749.18
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Medicare Advantage	$1,728.88
Rate for Payer: Aetna Commercial	$1,728.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.55
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	$1,469.55
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.18
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.44
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	411037214
Hospital Revenue Code	361
Min. Negotiated Rate	$864.44
Max. Negotiated Rate	$864.44
Rate for Payer: Qualcare PPO/HMO/WC	$864.44

THROMBOGEN,20,000U,SPRAY

Facility

$1,112.00

Hospital Charge Code	60635420
Hospital Revenue Code	250
Min. Negotiated Rate	$144.56
Max. Negotiated Rate	$556.00
Rate for Payer: Aetna Commercial	$333.60
Rate for Payer: Aetna Medicare Advantage	$333.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$283.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$283.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$283.56
Rate for Payer: Cigna Commercial	$556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.56
Rate for Payer: Oxford Commercial	$556.00
Rate for Payer: Qualcare PPO/HMO/WC	$166.80
Rate for Payer: UnitedHealthcare Commercial	$556.00

THROMBOGEN,20,000U,SPRAY

Facility

$1,112.00

Hospital Charge Code	60635420
Hospital Revenue Code	250
Min. Negotiated Rate	$166.80
Max. Negotiated Rate	$166.80
Rate for Payer: Qualcare PPO/HMO/WC	$166.80

THROMBOLYSIS

Facility

$2,765.00

Hospital Charge Code	2692180
Hospital Revenue Code	320
Min. Negotiated Rate	$359.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$829.50
Rate for Payer: Aetna Medicare Advantage	$829.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$705.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$705.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$705.08
Rate for Payer: Cigna Commercial	$1,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$414.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

THROMBOLYSIS

Facility

$2,765.00

Hospital Charge Code	2692180
Hospital Revenue Code	320
Min. Negotiated Rate	$414.75
Max. Negotiated Rate	$414.75
Rate for Payer: Qualcare PPO/HMO/WC	$414.75

THROMBOLYTIC ART THEARPY

Facility

$4,631.03

Service Code	HCPCS 37211
Hospital Charge Code	7411502
Hospital Revenue Code	361
Min. Negotiated Rate	$694.65
Max. Negotiated Rate	$694.65
Rate for Payer: Qualcare PPO/HMO/WC	$694.65

THROMBOLYTIC ART THEARPY

Facility

$4,631.03

Service Code	HCPCS 37211
Hospital Charge Code	7411502
Hospital Revenue Code	361
Min. Negotiated Rate	$602.03
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$1,389.31
Rate for Payer: Aetna Medicare Advantage	$1,389.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,180.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,180.91
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	$1,180.91
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$602.03
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$694.65
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	321037211
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$7,688.53
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
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	$6,535.25
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,331.70
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	411037211
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,397.01
Rate for Payer: Aetna Medicare Advantage	$6,397.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,437.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,437.45
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	$5,437.45
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.04
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	366837211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,198.50
Max. Negotiated Rate	$3,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50

THROMBOLYTIC ART THERAPY

Facility

$22,361.41

Service Code	HCPCS 37211
Hospital Charge Code	2692242
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,708.42
Rate for Payer: Aetna Medicare Advantage	$6,708.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,702.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,702.16
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	$5,702.16
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,906.98
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,354.21
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	321037211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	5600229
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	411037211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,198.50
Max. Negotiated Rate	$3,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	5600229
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$7,688.53
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
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	$6,535.25
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,331.70
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART THERAPY

Facility

$22,361.41

Service Code	HCPCS 37211
Hospital Charge Code	2692242
Hospital Revenue Code	361
Min. Negotiated Rate	$3,354.21
Max. Negotiated Rate	$3,354.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,354.21

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	366837211
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,397.01
Rate for Payer: Aetna Medicare Advantage	$6,397.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,437.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,437.45
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	$5,437.45
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,772.04
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

THROMBOLYTIC ART/VEN THEARPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	5600231
Hospital Revenue Code	361
Min. Negotiated Rate	$1,343.41
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$3,100.18
Rate for Payer: Aetna Medicare Advantage	$3,100.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,635.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,635.15
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	$2,635.15
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.41
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

THROMBOLYTIC ART/VEN THEARPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	5600231
Hospital Revenue Code	361
Min. Negotiated Rate	$1,550.09
Max. Negotiated Rate	$1,550.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09

Know your out-of-pocket cost for care.

All Charges