Heights University Hospital

All Charges

Charge

Type

Setting

Price

CFH PAP SMEAR

Facility

$35.00

Service Code	HCPCS 88142
Hospital Charge Code	83652289
Hospital Revenue Code	311
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.64
Rate for Payer: Aetna Medicare Advantage	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.23
Rate for Payer: Cigna Commercial	$20.26
Rate for Payer: Cigna Medicare Advantage	$10.13
Rate for Payer: Clover Medicare Advantage	$19.25
Rate for Payer: EmblemHealth Commercial	$60.78
Rate for Payer: Humana Medicare Advantage	$20.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.26
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.48
Rate for Payer: Wellcare Medicare Advantage	$20.26

CFH PAP SMEAR

Facility

$143.00

Service Code	HCPCS Q0091
Hospital Charge Code	83652640
Hospital Revenue Code	770
Min. Negotiated Rate	$18.59
Max. Negotiated Rate	$71.50
Rate for Payer: Aetna Commercial	$42.90
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.47
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.59
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$71.50

CFH PAP SMEAR

Facility

$143.00

Service Code	HCPCS Q0091
Hospital Charge Code	83652640
Hospital Revenue Code	770
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

CFH PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652645
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$42.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

CFH PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652645
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
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	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

CFH PED PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	83652485
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CFH PED PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	83652485
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CFH PED PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	83652483
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CFH PED PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	83652483
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CFH RW BRONCHODILATOR ADMIN

Facility

$171.00

Service Code	HCPCS 94664
Hospital Charge Code	83652381
Hospital Revenue Code	419
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$25.65

CFH RW BRONCHODILATOR ADMIN

Facility

$171.00

Service Code	HCPCS 94664
Hospital Charge Code	83652381
Hospital Revenue Code	419
Min. Negotiated Rate	$22.23
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.60
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.23
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.65
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

CFH RW HEPATITS A VACC ADULT

Facility

$91.00

Service Code	HCPCS 90632
Hospital Charge Code	83652303
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$91.24
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$73.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

CFH RW HEPATITS A VACC ADULT

Facility

$91.00

Service Code	HCPCS 90632
Hospital Charge Code	83652303
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

CFH RW PSYCHATRIC DIAGNOSTIC

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83652343
Hospital Revenue Code	900
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

CFH RW PSYCHATRIC DIAGNOSTIC

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83652343
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CFH RW PSY INDIV. 20-30MTS

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	83652347
Hospital Revenue Code	914
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$219.00
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

CFH RW PSY INDIV. 20-30MTS

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	83652347
Hospital Revenue Code	914
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

CFH RW PSY INDIV MD 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	83652351
Hospital Revenue Code	914
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$324.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

CFH RW PSY INDIV MD 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	83652351
Hospital Revenue Code	914
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

CFH RW TETANUS/DIPHTHERIA (TD)

Facility

$49.00

Service Code	HCPCS 90718
Hospital Charge Code	83652333
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

CFH RW TETANUS/DIPHTHERIA (TD)

Facility

$49.00

Service Code	HCPCS 90718
Hospital Charge Code	83652333
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

CFH RW TETANUS TOXOID

Facility

$130.00

Hospital Charge Code	83652323
Hospital Revenue Code	636
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

CFH RW TETANUS TOXOID

Facility

$130.00

Hospital Charge Code	83652323
Hospital Revenue Code	636
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

CFH SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	83652525
Hospital Revenue Code	770
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

CFH SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	83652525
Hospital Revenue Code	770
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

Know your out-of-pocket cost for care.

All Charges