Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO IV PUSH INITIAL MED

Facility

$431.00

Service Code	HCPCS 96409
Hospital Charge Code	93500081
Hospital Revenue Code	331
Min. Negotiated Rate	$56.03
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$129.30
Rate for Payer: Aetna Medicare Advantage	$129.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.91
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.03
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.65
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMO IV PUSH SINGLE DRUG

Facility

$584.75

Service Code	HCPCS 96409
Hospital Charge Code	485096409
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 SINGLE DRUG

Facility

$584.75

Service Code	HCPCS 96409
Hospital Charge Code	485096409
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	$786.58
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, SNGL DRUG

Facility

$584.75

Service Code	HCPCS 96409
Hospital Charge Code	3401090
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, SNGL DRUG

Facility

$584.75

Service Code	HCPCS 96409
Hospital Charge Code	3401090
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	$786.58
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 MULTI PREMIX****

Facility

$194.40

Service Code	HCPCS Q0083
Hospital Charge Code	3400157
Hospital Revenue Code	289
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$29.16
Rate for Payer: Qualcare PPO/HMO/WC	$29.16

CHEMO MULTI PREMIX****

Facility

$194.40

Service Code	HCPCS Q0083
Hospital Charge Code	3400157
Hospital Revenue Code	289
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Aetna Medicare Advantage	$58.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.57
Rate for Payer: Cigna Commercial	$97.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.27
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.16
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

CHEMO NEW PATIENT VISIT

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	3408035
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

CHEMO NEW PATIENT VISIT

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	3408035
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$128.57
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$8,198.80

Service Code	APR-DRG 6951
Min. Negotiated Rate	$5,892.65
Max. Negotiated Rate	$8,198.80
Rate for Payer: Aetna Better Health Medicaid	$8,038.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,198.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5,892.65

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$65,104.34

Service Code	APR-DRG 6954
Min. Negotiated Rate	$61,797.10
Max. Negotiated Rate	$65,104.34
Rate for Payer: Aetna Better Health Medicaid	$63,827.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,104.34
Rate for Payer: Wellpoint Medicaid Managed Care	$61,797.10

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$10,601.65

Service Code	APR-DRG 6952
Min. Negotiated Rate	$8,592.14
Max. Negotiated Rate	$10,601.65
Rate for Payer: Aetna Better Health Medicaid	$10,393.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,601.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8,592.14

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$22,404.84

Service Code	APR-DRG 6953
Min. Negotiated Rate	$20,148.73
Max. Negotiated Rate	$22,404.84
Rate for Payer: Aetna Better Health Medicaid	$20,148.73
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,551.70
Rate for Payer: Wellpoint Medicaid Managed Care	$22,404.84

CHEMOTHERAPY INTRACAVITARY

Facility

$1,292.25

Service Code	HCPCS 96446
Hospital Charge Code	3401106
Hospital Revenue Code	331
Min. Negotiated Rate	$167.99
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$387.68
Rate for Payer: Aetna Medicare Advantage	$387.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$329.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$329.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$329.52
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.99
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.84
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

CHEMOTHERAPY INTRACAVITARY

Facility

$1,292.25

Service Code	HCPCS 96446
Hospital Charge Code	3401106
Hospital Revenue Code	331
Min. Negotiated Rate	$193.84
Max. Negotiated Rate	$193.84
Rate for Payer: Qualcare PPO/HMO/WC	$193.84

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$162,000.42

Service Code	MSDRG 837
Min. Negotiated Rate	$47,902.35
Max. Negotiated Rate	$162,000.42
Rate for Payer: Aetna Commercial	$162,000.42
Rate for Payer: Aetna Medicare Advantage	$52,427.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133,424.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133,424.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50,423.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133,424.28
Rate for Payer: Cigna Commercial	$103,393.34
Rate for Payer: Cigna Medicare Advantage	$50,423.53
Rate for Payer: Clover Medicare Advantage	$47,902.35
Rate for Payer: EmblemHealth Commercial	$151,270.59
Rate for Payer: Humana Medicare Advantage	$51,936.24
Rate for Payer: Oxford Commercial	$64,617.83
Rate for Payer: UnitedHealthcare Commercial	$73,347.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$50,423.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$53,448.94
Rate for Payer: Wellcare Medicare Advantage	$50,423.53

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$72,410.55

Service Code	MSDRG 838
Min. Negotiated Rate	$22,778.93
Max. Negotiated Rate	$72,410.55
Rate for Payer: Aetna Commercial	$70,386.89
Rate for Payer: Aetna Medicare Advantage	$22,778.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,136.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,134.00
Rate for Payer: Cigna Commercial	$44,922.94
Rate for Payer: Cigna Medicare Advantage	$24,136.85
Rate for Payer: Clover Medicare Advantage	$22,930.01
Rate for Payer: EmblemHealth Commercial	$72,410.55
Rate for Payer: Humana Medicare Advantage	$24,860.96
Rate for Payer: Oxford Commercial	$28,075.53
Rate for Payer: UnitedHealthcare Commercial	$31,868.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,136.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,585.06
Rate for Payer: Wellcare Medicare Advantage	$24,136.85

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$53,732.49

Service Code	MSDRG 839
Min. Negotiated Rate	$15,756.68
Max. Negotiated Rate	$53,732.49
Rate for Payer: Aetna Commercial	$48,688.14
Rate for Payer: Aetna Medicare Advantage	$15,756.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,910.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,837.10
Rate for Payer: Cigna Commercial	$31,074.17
Rate for Payer: Cigna Medicare Advantage	$17,910.83
Rate for Payer: Clover Medicare Advantage	$17,015.29
Rate for Payer: EmblemHealth Commercial	$53,732.49
Rate for Payer: Humana Medicare Advantage	$18,448.15
Rate for Payer: Oxford Commercial	$19,420.46
Rate for Payer: UnitedHealthcare Commercial	$22,044.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,910.83
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18,985.48
Rate for Payer: Wellcare Medicare Advantage	$17,910.83

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$49,793.70

Service Code	MSDRG 847
Min. Negotiated Rate	$14,275.84
Max. Negotiated Rate	$49,793.70
Rate for Payer: Aetna Commercial	$44,112.35
Rate for Payer: Aetna Medicare Advantage	$14,275.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,356.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,356.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,597.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,356.07
Rate for Payer: Cigna Commercial	$28,153.77
Rate for Payer: Cigna Medicare Advantage	$16,597.90
Rate for Payer: Clover Medicare Advantage	$15,768.00
Rate for Payer: EmblemHealth Commercial	$49,793.70
Rate for Payer: Humana Medicare Advantage	$17,095.84
Rate for Payer: Oxford Commercial	$17,595.29
Rate for Payer: UnitedHealthcare Commercial	$19,972.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,597.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,593.77
Rate for Payer: Wellcare Medicare Advantage	$16,597.90

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$87,418.79

Service Code	MSDRG 846
Min. Negotiated Rate	$27,572.63
Max. Negotiated Rate	$87,418.79
Rate for Payer: Aetna Commercial	$87,418.79
Rate for Payer: Aetna Medicare Advantage	$28,290.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67,263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67,263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,023.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67,263.48
Rate for Payer: Cigna Commercial	$55,793.19
Rate for Payer: Cigna Medicare Advantage	$29,023.82
Rate for Payer: Clover Medicare Advantage	$27,572.63
Rate for Payer: EmblemHealth Commercial	$87,071.46
Rate for Payer: Humana Medicare Advantage	$29,894.53
Rate for Payer: Oxford Commercial	$34,869.12
Rate for Payer: UnitedHealthcare Commercial	$39,579.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,023.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$30,765.25
Rate for Payer: Wellcare Medicare Advantage	$29,023.82

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$36,476.67

Service Code	MSDRG 848
Min. Negotiated Rate	$9,269.15
Max. Negotiated Rate	$36,476.67
Rate for Payer: Aetna Commercial	$28,641.67
Rate for Payer: Aetna Medicare Advantage	$9,269.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,156.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,156.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,158.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,156.28
Rate for Payer: Cigna Commercial	$18,279.94
Rate for Payer: Cigna Medicare Advantage	$12,158.89
Rate for Payer: Clover Medicare Advantage	$11,550.95
Rate for Payer: EmblemHealth Commercial	$36,476.67
Rate for Payer: Humana Medicare Advantage	$12,523.66
Rate for Payer: Oxford Commercial	$11,424.43
Rate for Payer: UnitedHealthcare Commercial	$12,967.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,158.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,888.42
Rate for Payer: Wellcare Medicare Advantage	$12,158.89

CHEM SPECIAL***

Facility

$114.00

Hospital Charge Code	3010535
Hospital Revenue Code	301
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Commercial	$114.00

CHEM SPECIAL***

Facility

$114.00

Hospital Charge Code	3010535
Hospital Revenue Code	301
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

CHEMSTRIP 10 W/ SG

Facility

$265.00

Hospital Charge Code	60634428
Hospital Revenue Code	250
Min. Negotiated Rate	$34.45
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$79.50
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.45
Rate for Payer: Oxford Commercial	$132.50
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$132.50

CHEMSTRIP 10 W/ SG

Facility

$265.00

Hospital Charge Code	60634428
Hospital Revenue Code	250
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

Know your out-of-pocket cost for care.

All Charges