Heights University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE TRIAL SUBTULAR 10MM

Facility

$18,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698254
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.75
Max. Negotiated Rate	$9,312.50
Rate for Payer: Aetna Commercial	$5,587.50
Rate for Payer: Aetna Medicare Advantage	$5,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,749.38
Rate for Payer: Cigna Commercial	$9,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75

WEDGE TRI-CORT ILIAC LRG LIWLM

Facility

$3,224.00

Hospital Charge Code	270615746
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

WEDGE TRI-CORT ILIAC LRG LIWLM

Facility

$3,224.00

Hospital Charge Code	270615746
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$967.20
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

WEDGE ZIM TIB 7 16DEG 59880720

Facility

$4,437.65

Hospital Charge Code	270619816
Hospital Revenue Code	274
Min. Negotiated Rate	$665.65
Max. Negotiated Rate	$2,218.82
Rate for Payer: Aetna Commercial	$1,331.30
Rate for Payer: Aetna Medicare Advantage	$1,331.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,131.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,131.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,131.60
Rate for Payer: Cigna Commercial	$2,218.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.91
Rate for Payer: Qualcare PPO/HMO/WC	$665.65

WEDGE ZIM TIB 7 16DEG 59880720

Facility

$4,437.65

Hospital Charge Code	270619816
Hospital Revenue Code	274
Min. Negotiated Rate	$665.65
Max. Negotiated Rate	$1,073.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.91
Rate for Payer: Qualcare PPO/HMO/WC	$665.65

WEDGE ZIM TIB SZ6 5988-06-22

Facility

$4,306.45

Hospital Charge Code	270616163
Hospital Revenue Code	278
Min. Negotiated Rate	$645.97
Max. Negotiated Rate	$2,153.22
Rate for Payer: Aetna Commercial	$1,291.93
Rate for Payer: Aetna Medicare Advantage	$1,291.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,098.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,098.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,098.14
Rate for Payer: Cigna Commercial	$2,153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.16
Rate for Payer: Qualcare PPO/HMO/WC	$645.97

WEDGE ZIM TIB SZ6 5988-06-22

Facility

$4,306.45

Hospital Charge Code	270616163
Hospital Revenue Code	278
Min. Negotiated Rate	$645.97
Max. Negotiated Rate	$1,042.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.16
Rate for Payer: Qualcare PPO/HMO/WC	$645.97

WELLBUTRIN/100MG/TAB

Facility

$5.00

Hospital Charge Code	60634169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

WELLBUTRIN/100MG/TAB

Facility

$5.00

Hospital Charge Code	60634169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

WELLBUTRIN/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634236
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

WELLBUTRIN/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

WELLBUTRIN XL 150MG TABLT

Facility

$21.00

Hospital Charge Code	60635646
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

WELLBUTRIN XL 150MG TABLT

Facility

$21.00

Hospital Charge Code	60635646
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$103.89
Rate for Payer: Aetna Commercial	$62.33
Rate for Payer: Aetna Medicare Advantage	$62.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.98
Rate for Payer: Cigna Commercial	$103.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.01
Rate for Payer: Oxford Commercial	$103.89
Rate for Payer: Qualcare PPO/HMO/WC	$31.17
Rate for Payer: UnitedHealthcare Commercial	$103.89

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$31.17
Rate for Payer: Qualcare PPO/HMO/WC	$31.17

WESTCORT 0.2%/15GM

Facility

$56.00

Hospital Charge Code	60634171
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

WESTCORT 0.2%/15GM

Facility

$56.00

Hospital Charge Code	60634171
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

WESTCORT 0.2%/45GM

Facility

$107.00

Hospital Charge Code	60634170
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

WESTCORT 0.2%/45GM

Facility

$107.00

Hospital Charge Code	60634170
Hospital Revenue Code	250
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$32.10
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$53.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$53.50

WEST NILE AB

Facility

$565.60

Service Code	HCPCS 86789
Hospital Charge Code	397040002
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.84
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

WEST NILE AB

Facility

$565.60

Service Code	HCPCS 86789
Hospital Charge Code	397040002
Hospital Revenue Code	302
Min. Negotiated Rate	$84.84
Max. Negotiated Rate	$84.84
Rate for Payer: Qualcare PPO/HMO/WC	$84.84

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$17.36
Rate for Payer: Qualcare PPO/HMO/WC	$17.36

WEST NILE AB(IGG,IGM),CSF I

Facility

$115.75

Service Code	HCPCS 86788
Hospital Charge Code	39990109A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.36
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.84
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

WEST NILE AB(IGG,IGM),CSF II

Facility

$98.95

Service Code	HCPCS 86789
Hospital Charge Code	39990109B
Hospital Revenue Code	302
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$14.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.84

Know your out-of-pocket cost for care.

All Charges