Heights University Hospital

All Charges

Charge

Type

Setting

Price

FACTOR X STUART PROWER

Facility

$224.00

Service Code	HCPCS 85260
Hospital Charge Code	3004215
Hospital Revenue Code	305
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

FAMCICLOVIR 125 MG TAB

Facility

$19.25

Hospital Charge Code	60628817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

FAMCICLOVIR 125 MG TAB

Facility

$19.25

Hospital Charge Code	60628817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$10.25
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: Aetna Medicare Advantage	$23.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.11
Rate for Payer: Cigna Commercial	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.25
Rate for Payer: Oxford Commercial	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$11.83
Rate for Payer: UnitedHealthcare Commercial	$39.43

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.83

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$47.52
Rate for Payer: Aetna Medicare Advantage	$47.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.39
Rate for Payer: Cigna Commercial	$79.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.59
Rate for Payer: Oxford Commercial	$79.19
Rate for Payer: Qualcare PPO/HMO/WC	$23.76
Rate for Payer: UnitedHealthcare Commercial	$79.19

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$23.76
Rate for Payer: Qualcare PPO/HMO/WC	$23.76

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$23.17
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.52
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23.17

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

FAMILY COUNSEL WITHOUT PATIENT

Facility

$409.00

Service Code	HCPCS 90846
Hospital Charge Code	9310088
Hospital Revenue Code	916
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

FAMILY COUNSEL WITHOUT PATIENT

Facility

$409.00

Service Code	HCPCS 90846
Hospital Charge Code	9310088
Hospital Revenue Code	916
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$122.70
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

FAMILY COUNSEL WITH PATIENT

Facility

$409.00

Service Code	HCPCS 90847
Hospital Charge Code	9310087
Hospital Revenue Code	916
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$122.70
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84

FAMILY COUNSEL WITH PATIENT

Facility

$409.00

Service Code	HCPCS 90847
Hospital Charge Code	9310087
Hospital Revenue Code	916
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

FAMILY EDUCATION/CONF 1/4 HR.

Facility

$63.00

Hospital Charge Code	1008400
Hospital Revenue Code	420
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Medicare Advantage	$18.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.07
Rate for Payer: Cigna Commercial	$31.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

FAMILY EDUCATION/CONF 1/4 HR.

Facility

$63.00

Hospital Charge Code	1008400
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.45

FAMILY THERAPY

Facility

$165.80

Service Code	HCPCS 90847
Hospital Charge Code	50005
Hospital Revenue Code	916
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$24.87

FAMILY THERAPY

Facility

$165.80

Service Code	HCPCS 90847
Hospital Charge Code	50005
Hospital Revenue Code	916
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$49.74
Rate for Payer: Aetna Medicare Advantage	$49.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84

FAMILY THERAPY W/O PATIENT 50M

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546772
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY THERAPY W/O PATIENT 50M

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546772
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY THERAPY W/O PT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90846
Hospital Charge Code	4546752
Hospital Revenue Code	916
Min. Negotiated Rate	$142.22
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$328.20
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

FAMILY THERAPY W/O PT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90846
Hospital Charge Code	4546752
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

FAMILY THERAPY W/OPT 50 MIN IO

Facility

$1,094.00

Service Code	HCPCS 90846
Hospital Charge Code	4546745
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

FAMILY THERAPY W/OPT 50 MIN IO

Facility

$1,094.00

Service Code	HCPCS 90846
Hospital Charge Code	4546745
Hospital Revenue Code	916
Min. Negotiated Rate	$142.22
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$328.20
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

Know your out-of-pocket cost for care.

All Charges