Heights University Hospital

All Charges

Charge

Type

Setting

Price

B/P CUFF ADULT 1-TUBE

Facility

$55.40

Hospital Charge Code	27063317
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$27.70
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Medicare Advantage	$16.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.13
Rate for Payer: Cigna Commercial	$27.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$27.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.31
Rate for Payer: UnitedHealthcare Commercial	$27.70

B/P CUFF ADULT 1-TUBE

Facility

$55.40

Hospital Charge Code	27063317
Hospital Revenue Code	270
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$8.31
Rate for Payer: Qualcare PPO/HMO/WC	$8.31

B/P CUFF ADULT LG RESUSEABLE

Facility

$56.60

Hospital Charge Code	270649394
Hospital Revenue Code	270
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

B/P CUFF ADULT LG RESUSEABLE

Facility

$56.60

Hospital Charge Code	270649394
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Medicare Advantage	$16.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.43
Rate for Payer: Cigna Commercial	$28.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.36
Rate for Payer: Oxford Commercial	$28.30
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$28.30

BP CUFF REUSALBE LG ADULT

Facility

$48.65

Hospital Charge Code	270665395
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$24.32
Rate for Payer: Aetna Commercial	$14.60
Rate for Payer: Aetna Medicare Advantage	$14.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.41
Rate for Payer: Cigna Commercial	$24.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.32
Rate for Payer: Oxford Commercial	$24.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$24.32

BP CUFF REUSALBE LG ADULT

Facility

$48.65

Hospital Charge Code	270665395
Hospital Revenue Code	270
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$18,384.79

Service Code	APR-DRG 1324
Min. Negotiated Rate	$15,131.27
Max. Negotiated Rate	$18,384.79
Rate for Payer: Aetna Better Health Medicaid	$18,024.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,384.79
Rate for Payer: Wellpoint Medicaid Managed Care	$15,131.27

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$6,565.47

Service Code	APR-DRG 1322
Min. Negotiated Rate	$5,879.94
Max. Negotiated Rate	$6,565.47
Rate for Payer: Aetna Better Health Medicaid	$6,436.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,565.47
Rate for Payer: Wellpoint Medicaid Managed Care	$5,879.94

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$5,264.19

Service Code	APR-DRG 1321
Min. Negotiated Rate	$4,759.72
Max. Negotiated Rate	$5,264.19
Rate for Payer: Aetna Better Health Medicaid	$4,759.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,854.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5,264.19

BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$12,229.37

Service Code	APR-DRG 1323
Min. Negotiated Rate	$9,088.52
Max. Negotiated Rate	$12,229.37
Rate for Payer: Aetna Better Health Medicaid	$11,989.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,229.37
Rate for Payer: Wellpoint Medicaid Managed Care	$9,088.52

BPERTAB I

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.20
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

BPERTAB I

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084A
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

BPERTAB II

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.20
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

BPERTAB II

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084B
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

BPERTAB III

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.20
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

BPERTAB III

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084C
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

BPERTAB IV

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084D
Hospital Revenue Code	302
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.20
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

BPERTAB IV

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084D
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges