Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO INFUSION LEVEL HR 1

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3401000
Hospital Revenue Code	335
Min. Negotiated Rate	$161.51
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$372.72
Rate for Payer: Aetna Medicare Advantage	$372.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.81
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.51
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO INFUSION LEVEL HR 1

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3401000
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO INFUSN INTERIM MLTI IV**

Facility

$154.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400165
Hospital Revenue Code	289
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

CHEMO INFUSN INTERIM MLTI IV**

Facility

$154.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400165
Hospital Revenue Code	289
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$46.20
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.02
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

CHEMO INTO CNS

Facility

$1,234.69

Service Code	HCPCS 96450
Hospital Charge Code	3407001
Hospital Revenue Code	331
Min. Negotiated Rate	$160.51
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$370.41
Rate for Payer: Aetna Medicare Advantage	$370.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$314.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$314.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$314.85
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.51
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO INTO CNS

Facility

$1,234.69

Service Code	HCPCS 96450
Hospital Charge Code	3407001
Hospital Revenue Code	331
Min. Negotiated Rate	$185.20
Max. Negotiated Rate	$185.20
Rate for Payer: Qualcare PPO/HMO/WC	$185.20

CHEMO INTRATHECAL RESERVOIR

Facility

$884.30

Service Code	HCPCS 96542
Hospital Charge Code	3401107
Hospital Revenue Code	331
Min. Negotiated Rate	$114.96
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$265.29
Rate for Payer: Aetna Medicare Advantage	$265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.50
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.96
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.65
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO INTRATHECAL RESERVOIR

Facility

$884.30

Service Code	HCPCS 96542
Hospital Charge Code	3401107
Hospital Revenue Code	331
Min. Negotiated Rate	$132.65
Max. Negotiated Rate	$132.65
Rate for Payer: Qualcare PPO/HMO/WC	$132.65

CHEMO IV 16-90-EA ADD VAS

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3409035
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO IV 16-90-EA ADD VAS

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3409035
Hospital Revenue Code	335
Min. Negotiated Rate	$161.51
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$372.72
Rate for Payer: Aetna Medicare Advantage	$372.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.81
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.51
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO IV INFUS EACH ADDL SEQ

Facility

$293.10

Service Code	HCPCS 96417
Hospital Charge Code	3401105
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 IV INFUS EACH ADDL SEQ

Facility

$293.10

Service Code	HCPCS 96417
Hospital Charge Code	3401105
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO, IV INFUSION, ADDL HR 1

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401045
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO, IV INFUSION, ADDL HR 1

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401045
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, IV INFUSION, ADDL HR 7

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401050
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO, IV INFUSION, ADDL HR 7

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401050
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, IV INFUSION, ADDL HR 8

Facility

$234.48

Service Code	HCPCS 96415
Hospital Charge Code	3401055
Hospital Revenue Code	335
Min. Negotiated Rate	$35.17
Max. Negotiated Rate	$35.17
Rate for Payer: Qualcare PPO/HMO/WC	$35.17

CHEMO, IV INFUSION, ADDL HR 8

Facility

$234.48

Service Code	HCPCS 96415
Hospital Charge Code	3401055
Hospital Revenue Code	335
Min. Negotiated Rate	$30.48
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$70.34
Rate for Payer: Aetna Medicare Advantage	$70.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.79
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.48
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.17
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO IV PUSH-1ST MD INFU

Facility

$280.00

Service Code	HCPCS 96409
Hospital Charge Code	93500083
Hospital Revenue Code	331
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

CHEMO IV PUSH-1ST MD INFU

Facility

$280.00

Service Code	HCPCS 96409
Hospital Charge Code	93500083
Hospital Revenue Code	331
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$84.00
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO, IV PUSH, ADDL DRUG

Facility

$584.75

Service Code	HCPCS 96411
Hospital Charge Code	3401095
Hospital Revenue Code	331
Min. Negotiated Rate	$87.71
Max. Negotiated Rate	$87.71
Rate for Payer: Qualcare PPO/HMO/WC	$87.71

CHEMO, IV PUSH, ADDL DRUG

Facility

$584.75

Service Code	HCPCS 96411
Hospital Charge Code	3401095
Hospital Revenue Code	331
Min. Negotiated Rate	$76.02
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$175.43
Rate for Payer: Aetna Medicare Advantage	$175.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.11
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.02
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.71
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO IV PUSH EACH ADDT MED

Facility

$402.60

Service Code	HCPCS 96411
Hospital Charge Code	93500085
Hospital Revenue Code	331
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 IV PUSH EACH ADDT MED

Facility

$402.60

Service Code	HCPCS 96411
Hospital Charge Code	93500085
Hospital Revenue Code	331
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$60.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.39

CHEMO IV PUSH INITIAL MED

Facility

$431.00

Service Code	HCPCS 96409
Hospital Charge Code	93500081
Hospital Revenue Code	331
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$64.65

Know your out-of-pocket cost for care.

All Charges