Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH VERAPAMIL

Facility

$85.00

Service Code	HCPCS 80299
Hospital Charge Code	397073150
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

CH VIP

Facility

$390.00

Service Code	HCPCS 84586
Hospital Charge Code	397072020
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH VIP

Facility

$390.00

Service Code	HCPCS 84586
Hospital Charge Code	397072020
Hospital Revenue Code	301
Min. Negotiated Rate	$17.66
Max. Negotiated Rate	$129.45
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$35.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.45
Rate for Payer: Cigna Commercial	$35.33
Rate for Payer: Cigna Medicare Advantage	$17.66
Rate for Payer: Clover Medicare Advantage	$33.56
Rate for Payer: EmblemHealth Commercial	$105.99
Rate for Payer: Humana Medicare Advantage	$36.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.33
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.45
Rate for Payer: Wellcare Medicare Advantage	$35.33

CH VISCOSITY

Facility

$102.00

Service Code	HCPCS 85810
Hospital Charge Code	397071285
Hospital Revenue Code	305
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.81
Rate for Payer: Aetna Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.76
Rate for Payer: Cigna Commercial	$11.67
Rate for Payer: Cigna Medicare Advantage	$5.83
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.37
Rate for Payer: Wellcare Medicare Advantage	$11.67

CH VISCOSITY

Facility

$102.00

Service Code	HCPCS 85810
Hospital Charge Code	397071285
Hospital Revenue Code	305
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

CH VITAMIN A

Facility

$158.00

Service Code	HCPCS 84590
Hospital Charge Code	397071185
Hospital Revenue Code	301
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

CH VITAMIN A

Facility

$158.00

Service Code	HCPCS 84590
Hospital Charge Code	397071185
Hospital Revenue Code	301
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.54
Rate for Payer: Cigna Commercial	$11.61
Rate for Payer: Cigna Medicare Advantage	$5.80
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.31
Rate for Payer: Wellcare Medicare Advantage	$11.61

CH VITAMIN B1

Facility

$225.00

Service Code	HCPCS 84425
Hospital Charge Code	397071251
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.79
Rate for Payer: Aetna Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.79
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: Cigna Medicare Advantage	$10.62
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.50
Rate for Payer: Wellcare Medicare Advantage	$21.23

CH VITAMIN B1

Facility

$225.00

Service Code	HCPCS 84425
Hospital Charge Code	397071251
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH VITAMIN B12

Facility

$93.00

Service Code	HCPCS 82607
Hospital Charge Code	397071270
Hospital Revenue Code	301
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

CH VITAMIN B12

Facility

$93.00

Service Code	HCPCS 82607
Hospital Charge Code	397071270
Hospital Revenue Code	301
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.86
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.25
Rate for Payer: Cigna Commercial	$15.08
Rate for Payer: Cigna Medicare Advantage	$7.54
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.98
Rate for Payer: Wellcare Medicare Advantage	$15.08

CH VITAMIN B-2

Facility

$207.00

Service Code	HCPCS 84252
Hospital Charge Code	397073014
Hospital Revenue Code	301
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.16
Rate for Payer: Cigna Commercial	$20.24
Rate for Payer: Cigna Medicare Advantage	$10.12
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.45
Rate for Payer: Wellcare Medicare Advantage	$20.24

CH VITAMIN B-2

Facility

$207.00

Service Code	HCPCS 84252
Hospital Charge Code	397073014
Hospital Revenue Code	301
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

CH VITAMIN B-6

Facility

$446.00

Service Code	HCPCS 84207
Hospital Charge Code	397073015
Hospital Revenue Code	301
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

CH VITAMIN B-6

Facility

$446.00

Service Code	HCPCS 84207
Hospital Charge Code	397073015
Hospital Revenue Code	301
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Better Health Medicaid	$23,605.88
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.96
Rate for Payer: Cigna Commercial	$28.10
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.79
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00

CH VITAMIN B7 (BIOTIN)

Facility

$429.00

Service Code	HCPCS 84591
Hospital Charge Code	397071393
Hospital Revenue Code	301
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.27
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.51
Rate for Payer: Cigna Commercial	$17.06
Rate for Payer: Cigna Medicare Advantage	$8.53
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.08
Rate for Payer: Wellcare Medicare Advantage	$17.06

CH VITAMIN B7 (BIOTIN)

Facility

$429.00

Service Code	HCPCS 84591
Hospital Charge Code	397071393
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$64.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.35

CH VITAMIN C

Facility

$128.00

Service Code	HCPCS 82180
Hospital Charge Code	397073016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.48
Rate for Payer: Wellcare Medicare Advantage	$9.89

CH VITAMIN C

Facility

$128.00

Service Code	HCPCS 82180
Hospital Charge Code	397073016
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CH VITAMIN D

Facility

$202.00

Service Code	HCPCS 82306
Hospital Charge Code	394014001
Hospital Revenue Code	301
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$30.30
Rate for Payer: Qualcare PPO/HMO/WC	$30.30

CH VITAMIN D

Facility

$202.00

Service Code	HCPCS 82306
Hospital Charge Code	394014001
Hospital Revenue Code	301
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.90
Rate for Payer: Aetna Medicare Advantage	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.45
Rate for Payer: Cigna Commercial	$29.60
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$28.12
Rate for Payer: EmblemHealth Commercial	$88.80
Rate for Payer: Humana Medicare Advantage	$30.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.38
Rate for Payer: Wellcare Medicare Advantage	$29.60

CH VITAMIN D3

Facility

$470.00

Service Code	HCPCS 82306
Hospital Charge Code	397071346
Hospital Revenue Code	301
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.90
Rate for Payer: Aetna Medicare Advantage	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.45
Rate for Payer: Cigna Commercial	$29.60
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$28.12
Rate for Payer: EmblemHealth Commercial	$88.80
Rate for Payer: Humana Medicare Advantage	$30.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.38
Rate for Payer: Wellcare Medicare Advantage	$29.60

CH VITAMIN D3

Facility

$470.00

Service Code	HCPCS 82306
Hospital Charge Code	397071346
Hospital Revenue Code	301
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

CH VITAMIN E

Facility

$88.00

Service Code	HCPCS 84446
Hospital Charge Code	397073589
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

CH VITAMIN E

Facility

$88.00

Service Code	HCPCS 84446
Hospital Charge Code	397073589
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

Know your out-of-pocket cost for care.

All Charges