Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	485096413
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO ADMIN IV INFUS UP TO 1HR

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	93500087
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO ADMIN IV PUSH LEVEL 1

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3400132
Hospital Revenue Code	331
Min. Negotiated Rate	$48.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$112.88
Rate for Payer: Aetna Medicare Advantage	$112.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.94
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMIN IV PUSH LEVEL 1

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3400132
Hospital Revenue Code	331
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

CHEMO ADMIN IV PUSH LEVEL 2

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3401038
Hospital Revenue Code	331
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

CHEMO ADMIN IV PUSH LEVEL 2

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3401038
Hospital Revenue Code	331
Min. Negotiated Rate	$48.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$112.88
Rate for Payer: Aetna Medicare Advantage	$112.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.94
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMIN IV PUSH LEVEL 3

Facility

$327.00

Service Code	HCPCS 96405
Hospital Charge Code	3401039
Hospital Revenue Code	331
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

CHEMO ADMIN IV PUSH LEVEL 3

Facility

$327.00

Service Code	HCPCS 96405
Hospital Charge Code	3401039
Hospital Revenue Code	331
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$98.10
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.39
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.51
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMIN PERIT CAVITY IMPL

Facility

$1,158.00

Service Code	HCPCS 96446
Hospital Charge Code	93500095
Hospital Revenue Code	335
Min. Negotiated Rate	$150.54
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$347.40
Rate for Payer: Aetna Medicare Advantage	$347.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.29
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.54
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$173.70
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMIN PERIT CAVITY IMPL

Facility

$1,158.00

Service Code	HCPCS 96446
Hospital Charge Code	93500095
Hospital Revenue Code	335
Min. Negotiated Rate	$173.70
Max. Negotiated Rate	$173.70
Rate for Payer: Qualcare PPO/HMO/WC	$173.70

CHEMO ADMIN SUBQ/IM****

Facility

$49.00

Hospital Charge Code	3401006
Hospital Revenue Code	289
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$1,805.00
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	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

CHEMO ADMIN SUBQ/IM****

Facility

$49.00

Hospital Charge Code	3401006
Hospital Revenue Code	289
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

CHEMO ADMN IV ADDT INFS TO 1HR

Facility

$402.60

Service Code	HCPCS 96417
Hospital Charge Code	93500093
Hospital Revenue Code	335
Min. Negotiated Rate	$52.34
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$120.78
Rate for Payer: Aetna Medicare Advantage	$120.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.66
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.34
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.39
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMN IV ADDT INFS TO 1HR

Facility

$402.60

Service Code	HCPCS 96417
Hospital Charge Code	93500093
Hospital Revenue Code	335
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$60.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.39

CHEMO ADMN IV INFS ECH ADD HR

Facility

$210.90

Service Code	HCPCS 96415
Hospital Charge Code	93500091
Hospital Revenue Code	335
Min. Negotiated Rate	$27.42
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$63.27
Rate for Payer: Aetna Medicare Advantage	$63.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.78
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.42
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.64
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO ADMN IV INFS ECH ADD HR

Facility

$210.90

Service Code	HCPCS 96415
Hospital Charge Code	93500091
Hospital Revenue Code	335
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$31.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.64

CHEMO, ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96401
Hospital Charge Code	3401080
Hospital Revenue Code	331
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO, ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96401
Hospital Charge Code	3401080
Hospital Revenue Code	331
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$87.93
Rate for Payer: Aetna Medicare Advantage	$87.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.74
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	1600000603
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	16000750
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	1600000603
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,059.53
Rate for Payer: Aetna Commercial	$5,059.53
Rate for Payer: Aetna Medicare Advantage	$5,059.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,300.60
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,192.46
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	16000750
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,059.53
Rate for Payer: Aetna Commercial	$5,059.53
Rate for Payer: Aetna Medicare Advantage	$5,059.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,300.60
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,192.46
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CHEMODENERV TRUNK MUSC 1-5

Facility

$4,077.75

Service Code	HCPCS 64646
Hospital Charge Code	1600000550
Hospital Revenue Code	360
Min. Negotiated Rate	$611.66
Max. Negotiated Rate	$611.66
Rate for Payer: Qualcare PPO/HMO/WC	$611.66

CHEMODENERV TRUNK MUSC 1-5

Facility

$4,077.75

Service Code	HCPCS 64646
Hospital Charge Code	1600000550
Hospital Revenue Code	360
Min. Negotiated Rate	$530.11
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,223.33
Rate for Payer: Aetna Medicare Advantage	$1,223.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.83
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.11
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$611.66
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CHEMO,HARMON ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96402
Hospital Charge Code	3401085
Hospital Revenue Code	331
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$87.93
Rate for Payer: Aetna Medicare Advantage	$87.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.74
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

Know your out-of-pocket cost for care.

All Charges