Heights University Hospital

All Charges

Charge

Type

Setting

Price

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	671263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.56
Max. Negotiated Rate	$2,512.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56

BRIDGE 24CC

Facility

$12,487.50

Hospital Charge Code	270671264
Hospital Revenue Code	278
Min. Negotiated Rate	$1,873.12
Max. Negotiated Rate	$6,243.75
Rate for Payer: Aetna Commercial	$3,746.25
Rate for Payer: Aetna Medicare Advantage	$3,746.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,184.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,184.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,497.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,184.31
Rate for Payer: Cigna Commercial	$6,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,021.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,873.12

BRIDGE 24CC

Facility

$12,487.50

Hospital Charge Code	270671264
Hospital Revenue Code	278
Min. Negotiated Rate	$1,873.12
Max. Negotiated Rate	$3,021.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,021.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,873.12

BRIDGE 46CC

Facility

$17,850.00

Hospital Charge Code	270671265
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$4,319.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,319.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,677.50

BRIDGE 46CC

Facility

$17,850.00

Hospital Charge Code	270671265
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.50
Max. Negotiated Rate	$8,925.00
Rate for Payer: Aetna Commercial	$5,355.00
Rate for Payer: Aetna Medicare Advantage	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,551.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,551.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,551.75
Rate for Payer: Cigna Commercial	$8,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,319.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,677.50

BRIDGE LOOPOSTOMY

Facility

$29.65

Hospital Charge Code	270303152
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BRIDGE LOOPOSTOMY

Facility

$29.65

Hospital Charge Code	270303152
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

BRIDGE LOOPOSTOMY 7767*****

Facility

$34.00

Hospital Charge Code	8001356
Hospital Revenue Code	279
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

BRIDGE LOOPOSTOMY 7767*****

Facility

$34.00

Hospital Charge Code	8001356
Hospital Revenue Code	279
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

BRIDGE PLATE STR 2.0MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690770
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

BRIDGE PLATE STR 2.0MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690770
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

BRIEF EMOTIONAL/BEHAV ASSMT

Facility

$232.00

Service Code	HCPCS 96127
Hospital Charge Code	412396127
Hospital Revenue Code	510
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

BRIEF EMOTIONAL/BEHAV ASSMT

Facility

$232.00

Service Code	HCPCS 96127
Hospital Charge Code	412396127
Hospital Revenue Code	510
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$88.94
Rate for Payer: Aetna Commercial	$69.60
Rate for Payer: Aetna Medicare Advantage	$69.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

BRIEF MEDICATION VISIT***

Facility

$174.00

Service Code	HCPCS 90862
Hospital Charge Code	50007
Hospital Revenue Code	914
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

BRIEF MEDICATION VISIT***

Facility

$174.00

Service Code	HCPCS 90862
Hospital Charge Code	50007
Hospital Revenue Code	914
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

BRIEF VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99211WF
Hospital Charge Code	9600016
Hospital Revenue Code	519
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

BRIEF VISIT WHC*****

Facility

$25.30

Service Code	HCPCS 99211WF
Hospital Charge Code	9600016
Hospital Revenue Code	519
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$7.59
Rate for Payer: Aetna Medicare Advantage	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.45
Rate for Payer: Cigna Commercial	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

BRILINTA 60 MG (TICAGRELOR)

Facility

$36.45

Service Code	NDC 186077660
Hospital Charge Code	606390095
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

BRILINTA 60 MG (TICAGRELOR)

Facility

$36.45

Service Code	NDC 186077660
Hospital Charge Code	606390095
Hospital Revenue Code	250
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$18.23

BRILL BIT 2.0MM

Facility

$1,370.00

Hospital Charge Code	270661009
Hospital Revenue Code	272
Min. Negotiated Rate	$205.50
Max. Negotiated Rate	$205.50
Rate for Payer: Qualcare PPO/HMO/WC	$205.50

BRILL BIT 2.0MM

Facility

$1,370.00

Hospital Charge Code	270661009
Hospital Revenue Code	272
Min. Negotiated Rate	$178.10
Max. Negotiated Rate	$685.00
Rate for Payer: Aetna Commercial	$411.00
Rate for Payer: Aetna Medicare Advantage	$411.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.35
Rate for Payer: Cigna Commercial	$685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.10
Rate for Payer: Oxford Commercial	$685.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.50
Rate for Payer: UnitedHealthcare Commercial	$685.00

BRIMONIDINE SOL OPH 0.2%

Facility

$28.80

Hospital Charge Code	60628578
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

BRIMONIDINE SOL OPH 0.2%

Facility

$28.80

Hospital Charge Code	60628578
Hospital Revenue Code	250
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$8.64
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$14.40

BRINZOLAMIDE OPHTHALMIC 1% SUS

Facility

$393.75

Hospital Charge Code	60629909
Hospital Revenue Code	250
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$196.88
Rate for Payer: Aetna Commercial	$118.12
Rate for Payer: Aetna Medicare Advantage	$118.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.41
Rate for Payer: Cigna Commercial	$196.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.19
Rate for Payer: Oxford Commercial	$196.88
Rate for Payer: Qualcare PPO/HMO/WC	$59.06
Rate for Payer: UnitedHealthcare Commercial	$196.88

BRINZOLAMIDE OPHTHALMIC 1% SUS

Facility

$393.75

Hospital Charge Code	60629909
Hospital Revenue Code	250
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$59.06
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

Know your out-of-pocket cost for care.

All Charges