Heights University Hospital

All Charges

Charge

Type

Setting

Price

TONSILLECTOMY AGE LESS THAN AG

Facility

$42,339.20

Service Code	HCPCS 42825
Hospital Charge Code	1600000625
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Commercial	$12,701.76
Rate for Payer: Aetna Medicare Advantage	$12,701.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,796.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,796.50
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	$10,796.50
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,504.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

TOOL 14CM 5MM BA

Facility

$812.25

Hospital Charge Code	270657312
Hospital Revenue Code	270
Min. Negotiated Rate	$105.59
Max. Negotiated Rate	$406.12
Rate for Payer: Aetna Commercial	$243.68
Rate for Payer: Aetna Medicare Advantage	$243.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.12
Rate for Payer: Cigna Commercial	$406.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.59
Rate for Payer: Oxford Commercial	$406.12
Rate for Payer: Qualcare PPO/HMO/WC	$121.84
Rate for Payer: UnitedHealthcare Commercial	$406.12

TOOL 14CM 5MM BA

Facility

$812.25

Hospital Charge Code	270657312
Hospital Revenue Code	270
Min. Negotiated Rate	$121.84
Max. Negotiated Rate	$121.84
Rate for Payer: Qualcare PPO/HMO/WC	$121.84

TOOL AVENUE INSERTION 0449020

Facility

$14.00

Hospital Charge Code	270632534
Hospital Revenue Code	272
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

TOOL AVENUE INSERTION 0449020

Facility

$14.00

Hospital Charge Code	270632534
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

TOOL,BALL MIDAS REX LEGEND

Facility

$845.50

Hospital Charge Code	270690928
Hospital Revenue Code	272
Min. Negotiated Rate	$126.83
Max. Negotiated Rate	$126.83
Rate for Payer: Qualcare PPO/HMO/WC	$126.83

TOOL,BALL MIDAS REX LEGEND

Facility

$845.50

Hospital Charge Code	270690928
Hospital Revenue Code	272
Min. Negotiated Rate	$109.92
Max. Negotiated Rate	$422.75
Rate for Payer: Aetna Commercial	$253.65
Rate for Payer: Aetna Medicare Advantage	$253.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.60
Rate for Payer: Cigna Commercial	$422.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.92
Rate for Payer: Oxford Commercial	$422.75
Rate for Payer: Qualcare PPO/HMO/WC	$126.83
Rate for Payer: UnitedHealthcare Commercial	$422.75

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$5.79
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$9.65

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$5.79
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$9.65

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$5.79
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$9.65

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999
Hospital Revenue Code	272
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

TOOL, MIDAS REX DISSECTING

Facility

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$152.10
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$351.00
Rate for Payer: Aetna Medicare Advantage	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.35
Rate for Payer: Cigna Commercial	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.10
Rate for Payer: Oxford Commercial	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.50
Rate for Payer: UnitedHealthcare Commercial	$585.00

TOOL, MIDAS REX DISSECTING

Facility

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Qualcare PPO/HMO/WC	$175.50

TOOTHBRUSH YOUTH

Facility

$2.45

Hospital Charge Code	270300440
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TOOTHBRUSH YOUTH

Facility

$2.45

Hospital Charge Code	270300440
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

TOOTHETTE ORAL CARE ******

Facility

$19.00

Hospital Charge Code	8004376
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

TOOTHETTE ORAL CARE ******

Facility

$19.00

Hospital Charge Code	8004376
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

TOOTHETTE ORAL CARE KIT

Facility

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$15.13
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.56
Rate for Payer: Oxford Commercial	$25.23
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$25.23

TOOTHETTE ORAL CARE KIT

Facility

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

TOPAMAX 100MG TAB

Facility

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Commercial	$28.70
Rate for Payer: Aetna Medicare Advantage	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.40
Rate for Payer: Cigna Commercial	$47.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.44
Rate for Payer: Oxford Commercial	$47.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.35
Rate for Payer: UnitedHealthcare Commercial	$47.84

TOPAMAX 100MG TAB

Facility

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$14.35
Rate for Payer: Qualcare PPO/HMO/WC	$14.35

TOPAZ MICRODEBRIDER W/IFS

Facility

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$339.75
Max. Negotiated Rate	$339.75
Rate for Payer: Qualcare PPO/HMO/WC	$339.75

TOPAZ MICRODEBRIDER W/IFS

Facility

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$294.45
Max. Negotiated Rate	$1,132.50
Rate for Payer: Aetna Commercial	$679.50
Rate for Payer: Aetna Medicare Advantage	$679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$577.58
Rate for Payer: Cigna Commercial	$1,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.45
Rate for Payer: Oxford Commercial	$1,132.50
Rate for Payer: Qualcare PPO/HMO/WC	$339.75
Rate for Payer: UnitedHealthcare Commercial	$1,132.50

Know your out-of-pocket cost for care.

All Charges