Heights University Hospital

All Charges

Charge

Type

Setting

Price

EPSDT MUMPS VACCINE,SC

Facility

$590.75

Service Code	HCPCS 90704
Hospital Charge Code	9400350
Hospital Revenue Code	636
Min. Negotiated Rate	$88.61
Max. Negotiated Rate	$142.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.96
Rate for Payer: Qualcare PPO/HMO/WC	$88.61

EPSDT OFFICE CONSULTATION

Facility

$335.00

Service Code	HCPCS 99241
Hospital Charge Code	9400365
Hospital Revenue Code	510
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$167.50
Rate for Payer: Aetna Commercial	$100.50
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.55
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

EPSDT OFFICE CONSULTATION

Facility

$335.00

Service Code	HCPCS 99241
Hospital Charge Code	9400365
Hospital Revenue Code	510
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

EPSDT PNEUMOCOCCAL VACCINE

Facility

$79.40

Service Code	HCPCS 90732
Hospital Charge Code	9400355
Hospital Revenue Code	636
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$133.47
Rate for Payer: Aetna Commercial	$23.82
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$133.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

EPSDT PNEUMOCOCCAL VACCINE

Facility

$79.40

Service Code	HCPCS 90732
Hospital Charge Code	9400355
Hospital Revenue Code	636
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$19.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

EPSDT PURE TONE HEARING TEST

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	9400360
Hospital Revenue Code	471
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$1,180.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

EPSDT PURE TONE HEARING TEST

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	9400360
Hospital Revenue Code	471
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

EP shield, Absirbent, Scoop Fe

Facility

$143.75

Hospital Charge Code	270667572
Hospital Revenue Code	270
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$21.56
Rate for Payer: Qualcare PPO/HMO/WC	$21.56

EP shield, Absirbent, Scoop Fe

Facility

$143.75

Hospital Charge Code	270667572
Hospital Revenue Code	270
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$71.88
Rate for Payer: Aetna Commercial	$43.12
Rate for Payer: Aetna Medicare Advantage	$43.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.66
Rate for Payer: Cigna Commercial	$71.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.69
Rate for Payer: Oxford Commercial	$71.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.56
Rate for Payer: UnitedHealthcare Commercial	$71.88

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.71

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

EPSPT PSYCH SERVICE/THERAPY

Facility

$295.70

Service Code	HCPCS 90899
Hospital Charge Code	9400320
Hospital Revenue Code	900
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$88.71
Rate for Payer: Aetna Medicare Advantage	$88.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.40
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.44
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.35
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

EPSPT PSYCH SERVICE/THERAPY

Facility

$295.70

Service Code	HCPCS 90899
Hospital Charge Code	9400320
Hospital Revenue Code	900
Min. Negotiated Rate	$44.35
Max. Negotiated Rate	$44.35
Rate for Payer: Qualcare PPO/HMO/WC	$44.35

EPSTEIN-BARR AB PROFILE

Facility

$511.25

Hospital Charge Code	3004769
Hospital Revenue Code	302
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$255.62
Rate for Payer: Aetna Commercial	$153.38
Rate for Payer: Aetna Medicare Advantage	$153.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.37
Rate for Payer: Cigna Commercial	$255.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.69
Rate for Payer: UnitedHealthcare Commercial	$114.00

EPSTEIN-BARR AB PROFILE

Facility

$511.25

Hospital Charge Code	3004769
Hospital Revenue Code	302
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$76.69
Rate for Payer: Qualcare PPO/HMO/WC	$76.69

EPSTEIN BARR EA AB IGG

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004769D
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN BARR EA AB IGG

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004769D
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.51
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.07
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: Cigna Medicare Advantage	$6.56
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.91
Rate for Payer: Wellcare Medicare Advantage	$13.12

EPSTEIN BARR NUCL AG AB IGG

Facility

$127.85

Service Code	HCPCS 86664
Hospital Charge Code	3004769C
Hospital Revenue Code	302
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.54
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.02
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: Cigna Medicare Advantage	$7.64
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.21
Rate for Payer: Wellcare Medicare Advantage	$15.29

EPSTEIN BARR NUCL AG AB IGG

Facility

$127.85

Service Code	HCPCS 86664
Hospital Charge Code	3004769C
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.77
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.46
Rate for Payer: Cigna Commercial	$18.14
Rate for Payer: Cigna Medicare Advantage	$9.07
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
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	$18.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.23
Rate for Payer: Wellcare Medicare Advantage	$18.14

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769A
Hospital Revenue Code	302
Min. Negotiated Rate	$16.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.35
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$114.00

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769A
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN-BARR VCA, EACH

Facility

$127.85

Service Code	HCPCS 8666591
Hospital Charge Code	3004769B
Hospital Revenue Code	302
Min. Negotiated Rate	$16.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.35
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges