Heights University Hospital

All Charges

Charge

Type

Setting

Price

TOMOSYNTHESIS SCREEN BREST UNI

Facility

$130.10

Service Code	HCPCS 7706352
Hospital Charge Code	94061472
Hospital Revenue Code	403
Min. Negotiated Rate	$16.91
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$39.03
Rate for Payer: Aetna Medicare Advantage	$39.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.18
Rate for Payer: Cigna Commercial	$65.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.91
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.52
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

TOMOSYNTHESIS SCREEN BREST UNI

Facility

$130.10

Service Code	HCPCS 7706352
Hospital Charge Code	94061472
Hospital Revenue Code	403
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$19.52
Rate for Payer: Qualcare PPO/HMO/WC	$19.52

TOMOSYNTHESIS SCREEN BRST UNI

Facility

$130.10

Service Code	HCPCS 7706352
Hospital Charge Code	94061473
Hospital Revenue Code	403
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$19.52
Rate for Payer: Qualcare PPO/HMO/WC	$19.52

TOMOSYNTHESIS SCREEN BRST UNI

Facility

$130.10

Service Code	HCPCS 7706352
Hospital Charge Code	94061473
Hospital Revenue Code	403
Min. Negotiated Rate	$16.91
Max. Negotiated Rate	$1,240.00
Rate for Payer: Cigna Commercial	$65.05
Rate for Payer: Aetna Commercial	$39.03
Rate for Payer: Aetna Medicare Advantage	$39.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.91
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.52
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

TONG LOCKING PLASTIC 7

Facility

$3.55

Hospital Charge Code	27600994
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.77
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna Medicare Advantage	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.91
Rate for Payer: Cigna Commercial	$1.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.46
Rate for Payer: Oxford Commercial	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.53
Rate for Payer: UnitedHealthcare Commercial	$1.77

TONG LOCKING PLASTIC 7

Facility

$3.55

Hospital Charge Code	27600994
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Qualcare PPO/HMO/WC	$0.53

TONG LOCKING PLASTIC 7****

Facility

$3.55

Hospital Charge Code	270600994
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.77
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna Medicare Advantage	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.91
Rate for Payer: Cigna Commercial	$1.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.46
Rate for Payer: Oxford Commercial	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.53
Rate for Payer: UnitedHealthcare Commercial	$1.77

TONG LOCKING PLASTIC 7****

Facility

$3.55

Hospital Charge Code	270600994
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Qualcare PPO/HMO/WC	$0.53

TONOCARD 400/BULK/TAB

Facility

$3.00

Hospital Charge Code	60634690
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

TONOCARD 400/BULK/TAB

Facility

$3.00

Hospital Charge Code	60634690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TONOCARD/400MG/TAB

Facility

$6.00

Hospital Charge Code	60634043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TONOCARD/400MG/TAB

Facility

$6.00

Hospital Charge Code	60634043
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

TONOCARD/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TONOCARD/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634235
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

TONSIL & ADENOID KIT

Facility

$76.00

Hospital Charge Code	270338752
Hospital Revenue Code	272
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$22.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.38
Rate for Payer: Cigna Commercial	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.88
Rate for Payer: Oxford Commercial	$38.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.40
Rate for Payer: UnitedHealthcare Commercial	$38.00

TONSIL & ADENOID KIT

Facility

$76.00

Hospital Charge Code	270338752
Hospital Revenue Code	272
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$11.40

TONSIL AND ADENOID PROCEDURES

Facility

$17,383.40

Service Code	APR-DRG 0973
Min. Negotiated Rate	$13,563.70
Max. Negotiated Rate	$17,383.40
Rate for Payer: Aetna Better Health Medicaid	$17,042.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,383.40
Rate for Payer: Wellpoint Medicaid Managed Care	$13,563.70

TONSIL AND ADENOID PROCEDURES

Facility

$45,824.36

Service Code	APR-DRG 0974
Min. Negotiated Rate	$32,152.08
Max. Negotiated Rate	$45,824.36
Rate for Payer: Aetna Better Health Medicaid	$32,152.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,795.12
Rate for Payer: Wellpoint Medicaid Managed Care	$45,824.36

TONSIL AND ADENOID PROCEDURES

Facility

$10,930.33

Service Code	APR-DRG 0972
Min. Negotiated Rate	$6,980.10
Max. Negotiated Rate	$10,930.33
Rate for Payer: Aetna Better Health Medicaid	$10,716.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,930.33
Rate for Payer: Wellpoint Medicaid Managed Care	$6,980.10

TONSIL AND ADENOID PROCEDURES

Facility

$7,427.74

Service Code	APR-DRG 0971
Min. Negotiated Rate	$4,547.04
Max. Negotiated Rate	$7,427.74
Rate for Payer: Aetna Better Health Medicaid	$7,282.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,427.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4,547.04

TONSILLECTOMY - AGE 12 OR MORE

Facility

$22,083.40

Service Code	HCPCS 42826
Hospital Charge Code	1600000282
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$6,625.02
Rate for Payer: Aetna Medicare Advantage	$6,625.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,631.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,631.27
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	$5,631.27
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.84
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TONSILLECTOMY - AGE 12 OR MORE

Facility

$22,083.40

Service Code	HCPCS 42826
Hospital Charge Code	1600000294
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$6,625.02
Rate for Payer: Aetna Medicare Advantage	$6,625.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,631.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,631.27
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	$5,631.27
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,870.84
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TONSILLECTOMY - AGE 12 OR MORE

Facility

$22,083.40

Service Code	HCPCS 42826
Hospital Charge Code	1600000282
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

TONSILLECTOMY - AGE 12 OR MORE

Facility

$22,083.40

Service Code	HCPCS 42826
Hospital Charge Code	1600000294
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

TONSILLECTOMY AGE LESS THAN AG

Facility

$42,339.20

Service Code	HCPCS 42825
Hospital Charge Code	1600000625
Hospital Revenue Code	360
Min. Negotiated Rate	$6,350.88
Max. Negotiated Rate	$6,350.88
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88

Know your out-of-pocket cost for care.

All Charges