Heights University Hospital

All Charges

Charge

Type

Setting

Price

TORQUE SHAFT

Facility

$4,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270685773
Hospital Revenue Code	278
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,275.00
Rate for Payer: Aetna Commercial	$1,365.00
Rate for Payer: Aetna Medicare Advantage	$1,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,160.25
Rate for Payer: Cigna Commercial	$2,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$682.50

TORQUE SHAFT

Facility

$4,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270685773
Hospital Revenue Code	278
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$1,101.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$682.50

TORSEMIDE 10 MG TAB

Facility

$4.69

Service Code	NDC 31722053001
Hospital Charge Code	60628726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

TORSEMIDE 10 MG TAB

Facility

$4.69

Service Code	NDC 31722053001
Hospital Charge Code	60628726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.41
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.61
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$2.35

TORSEMIDE 20MG/2ML

Facility

$37.00

Hospital Charge Code	60635728
Hospital Revenue Code	250
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.81
Rate for Payer: Oxford Commercial	$18.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$18.50

TORSEMIDE 20MG/2ML

Facility

$37.00

Hospital Charge Code	60635728
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

TORSEMIDE 20 MG/2ML INJ

Facility

$16.85

Hospital Charge Code	60628796
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

TORSEMIDE 20 MG/2ML INJ

Facility

$16.85

Hospital Charge Code	60628796
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.43

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$7.42
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.30
Rate for Payer: Cigna Commercial	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Oxford Commercial	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$12.36

TORSEMIDE 50 MG/5ML INJ

Facility

$12.40

Hospital Charge Code	60628727
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare Advantage	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.16
Rate for Payer: Cigna Commercial	$6.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$6.20

TORSEMIDE 50 MG/5ML INJ

Facility

$12.40

Hospital Charge Code	60628727
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.55
Rate for Payer: Oxford Commercial	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$2.11

TOTAL BILI, DIR/IND PANEL***

Facility

$7.20

Service Code	HCPCS 82251
Hospital Charge Code	3000437P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$2.16
Rate for Payer: Aetna Medicare Advantage	$2.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.84
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$114.00

TOTAL BILI, DIR/IND PANEL***

Facility

$7.20

Service Code	HCPCS 82251
Hospital Charge Code	3000437P
Hospital Revenue Code	301
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$11,439.00
Max. Negotiated Rate	$11,439.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$22,878.00
Rate for Payer: Aetna Medicare Advantage	$22,878.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,446.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,446.30
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	$19,446.30
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,913.80
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$170.40
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.84
Rate for Payer: Oxford Commercial	$284.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$284.00

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$22,729.11
Rate for Payer: Aetna Medicare Advantage	$22,729.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,319.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,319.74
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	$19,319.74
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,849.28
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$11,364.56
Max. Negotiated Rate	$11,364.56
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56

TOTAL IGA BY NEPHELOMETRY

Facility

$30.00

Service Code	HCPCS 82784
Hospital Charge Code	3035163
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

TOTAL IGA BY NEPHELOMETRY

Facility

$30.00

Service Code	HCPCS 82784
Hospital Charge Code	3035163
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

TOTAL IRON BINDING CAPACITY

Facility

$667.59

Service Code	HCPCS 83550
Hospital Charge Code	3009289
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges