Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO,HARMON ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96402
Hospital Charge Code	3401085
Hospital Revenue Code	331
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO HORMON ANTI-NEOPL SQ/IM

Facility

$260.00

Service Code	HCPCS 96402
Hospital Charge Code	93500181
Hospital Revenue Code	331
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO HORMON ANTI-NEOPL SQ/IM

Facility

$260.00

Service Code	HCPCS 96402
Hospital Charge Code	93500181
Hospital Revenue Code	331
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

CHEMO IM/SQ NON HORM

Facility

$210.90

Service Code	HCPCS 96401
Hospital Charge Code	93500079
Hospital Revenue Code	331
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 IM/SQ NON HORM

Facility

$210.90

Service Code	HCPCS 96401
Hospital Charge Code	93500079
Hospital Revenue Code	331
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$31.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.64

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$355.76

Service Code	HCPCS 96425
Hospital Charge Code	93500182
Hospital Revenue Code	335
Min. Negotiated Rate	$53.36
Max. Negotiated Rate	$53.36
Rate for Payer: Qualcare PPO/HMO/WC	$53.36

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$917.00

Service Code	HCPCS 96425
Hospital Charge Code	3401155
Hospital Revenue Code	335
Min. Negotiated Rate	$137.55
Max. Negotiated Rate	$137.55
Rate for Payer: Qualcare PPO/HMO/WC	$137.55

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$355.76

Service Code	HCPCS 96425
Hospital Charge Code	93500182
Hospital Revenue Code	335
Min. Negotiated Rate	$46.25
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$106.73
Rate for Payer: Aetna Medicare Advantage	$106.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.72
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.25
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.36
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$917.00

Service Code	HCPCS 96425
Hospital Charge Code	3401155
Hospital Revenue Code	335
Min. Negotiated Rate	$119.21
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$275.10
Rate for Payer: Aetna Medicare Advantage	$275.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.84
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.21
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.55
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO INFUSE W/PUMP >8 HRS

Facility

$1,778.80

Service Code	HCPCS 96416
Hospital Charge Code	93500092
Hospital Revenue Code	335
Min. Negotiated Rate	$266.82
Max. Negotiated Rate	$266.82
Rate for Payer: Qualcare PPO/HMO/WC	$266.82

CHEMO INFUSE W/PUMP >8 HRS

Facility

$1,778.80

Service Code	HCPCS 96416
Hospital Charge Code	93500092
Hospital Revenue Code	335
Min. Negotiated Rate	$231.24
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$533.64
Rate for Payer: Aetna Medicare Advantage	$533.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.59
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.24
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.82
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO INFUSION ADD'L 1 HR***

Facility

$111.00

Service Code	HCPCS Q0085
Hospital Charge Code	3400181
Hospital Revenue Code	289
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

CHEMO INFUSION ADD'L 1 HR***

Facility

$111.00

Service Code	HCPCS Q0085
Hospital Charge Code	3400181
Hospital Revenue Code	289
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

CHEMO INFUSION ADDL LEVEL HR 2

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401001
Hospital Revenue Code	335
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

CHEMO INFUSION ADDL LEVEL HR 2

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401001
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 3

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401002
Hospital Revenue Code	335
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

CHEMO INFUSION ADDL LEVEL HR 3

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401002
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 4

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401017
Hospital Revenue Code	335
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

CHEMO INFUSION ADDL LEVEL HR 4

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401017
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 5

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401018
Hospital Revenue Code	335
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

CHEMO INFUSION ADDL LEVEL HR 5

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401018
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 6

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401019
Hospital Revenue Code	335
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

CHEMO INFUSION ADDL LEVEL HR 6

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401019
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION COMPLEX****

Facility

$216.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400173
Hospital Revenue Code	289
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$64.80
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.08
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

CHEMO INFUSION COMPLEX****

Facility

$216.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400173
Hospital Revenue Code	289
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

Know your out-of-pocket cost for care.

All Charges