Heights University Hospital

All Charges

Charge

Type

Setting

Price

UTLTY CART W/3 TUB SHELVES BLU

Facility

$712.50

Hospital Charge Code	270662654
Hospital Revenue Code	270
Min. Negotiated Rate	$106.88
Max. Negotiated Rate	$106.88
Rate for Payer: Qualcare PPO/HMO/WC	$106.88

V 8600 - PRIMARY PUMP SET***

Facility

$23.00

Hospital Charge Code	7000680
Hospital Revenue Code	279
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

V 8600 - PRIMARY PUMP SET***

Facility

$23.00

Hospital Charge Code	7000680
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

V92 CELLULAR BONE MATRIX

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270687475
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

V92 CELLULAR BONE MATRIX

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270687475
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

VABGUARD DCM TIBILA BEARING 16

Facility

$12,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270665906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$3,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

VABGUARD DCM TIBILA BEARING 16

Facility

$12,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270665906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$6,282.50
Rate for Payer: Aetna Commercial	$3,769.50
Rate for Payer: Aetna Medicare Advantage	$3,769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,204.07
Rate for Payer: Cigna Commercial	$6,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

VACC ADMIN < 18 YRS EA ADD VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	87502705
Hospital Revenue Code	771
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

VACC ADMIN < 18 YRS EA ADD VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	87502705
Hospital Revenue Code	771
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$9.30
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$9.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.03
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACC ADMIN < 18 YRS INIT VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	87502700
Hospital Revenue Code	771
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$26.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACC ADMIN < 18 YRS INIT VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	87502700
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

VACCESS POWER POR 8FR

Facility

$1,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270653938
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

VACCESS POWER POR 8FR

Facility

$1,075.00

Service Code	HCPCS C1788
Hospital Charge Code	270653938
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	100143
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	5700810
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93500184
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	93950063
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	5700810
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	87502255
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	8200501
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	100143
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83652297
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83090030
Hospital Revenue Code	771
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$26.72
Rate for Payer: Aetna Medicare Advantage	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.71
Rate for Payer: Cigna Commercial	$18.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.58
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.36
Rate for Payer: UnitedHealthcare Commercial	$103.00

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	83090030
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

VACCINE ADMIN EA ADDL

Facility

$89.07

Service Code	HCPCS 90472
Hospital Charge Code	8200501
Hospital Revenue Code	771
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$13.36
Rate for Payer: Qualcare PPO/HMO/WC	$13.36

Know your out-of-pocket cost for care.

All Charges