Heights University Hospital

All Charges

Charge

Type

Setting

Price

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$5,186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$10,715.00
Rate for Payer: Aetna Commercial	$6,429.00
Rate for Payer: Aetna Medicare Advantage	$6,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.65
Rate for Payer: Cigna Commercial	$10,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$501.97
Rate for Payer: Aetna Commercial	$443.88
Rate for Payer: Aetna Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.97
Rate for Payer: Cigna Commercial	$137.00
Rate for Payer: Cigna Medicare Advantage	$68.50
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$145.22
Rate for Payer: Wellcare Medicare Advantage	$137.00

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,840.37
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	$3,829.26
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

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
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

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$878.25
Max. Negotiated Rate	$1,416.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: Qualcare PPO/HMO/WC	$878.25

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$878.25
Max. Negotiated Rate	$2,927.50
Rate for Payer: Aetna Commercial	$1,756.50
Rate for Payer: Aetna Medicare Advantage	$1,756.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.03
Rate for Payer: Cigna Commercial	$2,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: Qualcare PPO/HMO/WC	$878.25

TNK 50MG-TRANSPORT BOX

Facility

$17,131.00

Hospital Charge Code	60635395
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.65
Max. Negotiated Rate	$8,565.50
Rate for Payer: Aetna Commercial	$5,139.30
Rate for Payer: Aetna Medicare Advantage	$5,139.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,368.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,368.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,368.40
Rate for Payer: Cigna Commercial	$8,565.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,145.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.65

TNK 50MG-TRANSPORT BOX

Facility

$17,131.00

Hospital Charge Code	60635395
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.65
Max. Negotiated Rate	$4,145.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,145.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.65

TNKASE KIT 50MG VIAL

Facility

$2,482.00

Hospital Charge Code	60635302
Hospital Revenue Code	636
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$1,241.00
Rate for Payer: Aetna Commercial	$744.60
Rate for Payer: Aetna Medicare Advantage	$744.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.91
Rate for Payer: Cigna Commercial	$1,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: Qualcare PPO/HMO/WC	$372.30

TNKASE KIT 50MG VIAL

Facility

$2,482.00

Hospital Charge Code	60635302
Hospital Revenue Code	636
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$600.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: Qualcare PPO/HMO/WC	$372.30

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$779.00
Rate for Payer: Aetna Commercial	$53.41
Rate for Payer: Aetna Medicare Advantage	$53.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.40
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.15
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$779.00

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$779.00
Rate for Payer: Aetna Commercial	$53.41
Rate for Payer: Aetna Medicare Advantage	$53.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.40
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.15
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$779.00

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.26
Rate for Payer: Aetna Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.10
Rate for Payer: Cigna Commercial	$16.13
Rate for Payer: Cigna Medicare Advantage	$8.06
Rate for Payer: Clover Medicare Advantage	$15.32
Rate for Payer: EmblemHealth Commercial	$48.39
Rate for Payer: Humana Medicare Advantage	$16.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.10
Rate for Payer: Wellcare Medicare Advantage	$16.13

TOBRAMYCIN

Facility

$136.85

Service Code	HCPCS 80200
Hospital Charge Code	3004025
Hospital Revenue Code	301
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.26
Rate for Payer: Aetna Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.10
Rate for Payer: Cigna Commercial	$16.13
Rate for Payer: Cigna Medicare Advantage	$8.06
Rate for Payer: Clover Medicare Advantage	$15.32
Rate for Payer: EmblemHealth Commercial	$48.39
Rate for Payer: Humana Medicare Advantage	$16.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.13
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.10
Rate for Payer: Wellcare Medicare Advantage	$16.13

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

TOBRAMYCIN

Facility

$136.85

Service Code	HCPCS 80200
Hospital Charge Code	3004025
Hospital Revenue Code	301
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

TOBRAMYCIN 0.3%/DEX OPTH SUSP

Facility

$374.43

Hospital Charge Code	606350910
Hospital Revenue Code	250
Min. Negotiated Rate	$48.68
Max. Negotiated Rate	$187.22
Rate for Payer: Aetna Commercial	$112.33
Rate for Payer: Aetna Medicare Advantage	$112.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.48
Rate for Payer: Cigna Commercial	$187.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.68
Rate for Payer: Oxford Commercial	$187.22
Rate for Payer: Qualcare PPO/HMO/WC	$56.16
Rate for Payer: UnitedHealthcare Commercial	$187.22

TOBRAMYCIN 0.3%/DEX OPTH SUSP

Facility

$374.43

Hospital Charge Code	606350910
Hospital Revenue Code	250
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$56.16
Rate for Payer: Qualcare PPO/HMO/WC	$56.16

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$194.93
Max. Negotiated Rate	$749.73
Rate for Payer: Aetna Commercial	$449.84
Rate for Payer: Aetna Medicare Advantage	$449.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.36
Rate for Payer: Cigna Commercial	$749.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.93
Rate for Payer: Oxford Commercial	$749.73
Rate for Payer: Qualcare PPO/HMO/WC	$224.92
Rate for Payer: UnitedHealthcare Commercial	$749.73

Know your out-of-pocket cost for care.

All Charges