Heights University Hospital

All Charges

Charge

Type

Setting

Price

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4504521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4527521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4518521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4832521
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4822521
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4535521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4518521
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4824521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4504521
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP THERAPY CHILD

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4515521
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

GROWTH HORMONE

Facility

$114.65

Service Code	HCPCS 83003
Hospital Charge Code	39900089
Hospital Revenue Code	301
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.20

GROWTH HORMONE

Facility

$390.00

Service Code	HCPCS 83003
Hospital Charge Code	38472329
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GROWTH HORMONE

Facility

$390.00

Service Code	HCPCS 83003
Hospital Charge Code	38472329
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.01
Rate for Payer: Aetna Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.08
Rate for Payer: Cigna Commercial	$16.67
Rate for Payer: Cigna Medicare Advantage	$8.34
Rate for Payer: Clover Medicare Advantage	$15.84
Rate for Payer: EmblemHealth Commercial	$50.01
Rate for Payer: Humana Medicare Advantage	$17.17
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	$16.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.67
Rate for Payer: Wellcare Medicare Advantage	$16.67

GROWTH HORMONE

Facility

$114.65

Service Code	HCPCS 83003
Hospital Charge Code	39900089
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.01
Rate for Payer: Aetna Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.08
Rate for Payer: Cigna Commercial	$16.67
Rate for Payer: Cigna Medicare Advantage	$8.34
Rate for Payer: Clover Medicare Advantage	$15.84
Rate for Payer: EmblemHealth Commercial	$50.01
Rate for Payer: Humana Medicare Advantage	$17.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.67
Rate for Payer: Wellcare Medicare Advantage	$16.67

GROWTH HORMONE, SERUM

Facility

$187.25

Service Code	HCPCS 83003
Hospital Charge Code	3001476
Hospital Revenue Code	301
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

GROWTH HORMONE, SERUM

Facility

$187.25

Service Code	HCPCS 83003
Hospital Charge Code	3001476
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.01
Rate for Payer: Aetna Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.08
Rate for Payer: Cigna Commercial	$16.67
Rate for Payer: Cigna Medicare Advantage	$8.34
Rate for Payer: Clover Medicare Advantage	$15.84
Rate for Payer: EmblemHealth Commercial	$50.01
Rate for Payer: Humana Medicare Advantage	$17.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.67
Rate for Payer: Wellcare Medicare Advantage	$16.67

G TUBE BALLOON REPL 16FR 6216

Facility

$148.85

Hospital Charge Code	270629059
Hospital Revenue Code	272
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$74.42
Rate for Payer: Aetna Commercial	$44.66
Rate for Payer: Aetna Medicare Advantage	$44.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.96
Rate for Payer: Cigna Commercial	$74.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.35
Rate for Payer: Oxford Commercial	$74.42
Rate for Payer: Qualcare PPO/HMO/WC	$22.33
Rate for Payer: UnitedHealthcare Commercial	$74.42

G TUBE BALLOON REPL 16FR 6216

Facility

$148.85

Hospital Charge Code	270629059
Hospital Revenue Code	272
Min. Negotiated Rate	$22.33
Max. Negotiated Rate	$22.33
Rate for Payer: Qualcare PPO/HMO/WC	$22.33

G TUBE BALLOON REPL 18FR 6218

Facility

$136.50

Hospital Charge Code	270629060
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: Aetna Medicare Advantage	$40.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.81
Rate for Payer: Cigna Commercial	$68.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.75
Rate for Payer: Oxford Commercial	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.48
Rate for Payer: UnitedHealthcare Commercial	$68.25

G TUBE BALLOON REPL 18FR 6218

Facility

$136.50

Hospital Charge Code	270629060
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$20.48
Rate for Payer: Qualcare PPO/HMO/WC	$20.48

GUAIFCNESIN DM SYRUP 5ML

Facility

$1.95

Hospital Charge Code	6023295
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

GUAIFCNESIN DM SYRUP 5ML

Facility

$1.95

Hospital Charge Code	6023295
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

GUAIFENESIN/100MG/5ML

Facility

$1.00

Hospital Charge Code	60633057
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

GUAIFENESIN/100MG/5ML

Facility

$1.00

Hospital Charge Code	60633057
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

GUAIFENESIN 100 MG/5 ML LIQ

Facility

$4.02

Service Code	NDC 121174405
Hospital Charge Code	60627996
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges