Heights University Hospital

All Charges

Charge

Type

Setting

Price

INDINAVIR SULFATE 400 MG CAP

Facility

$20.85

Hospital Charge Code	60628814
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

INDIRECT COOMBS

Facility

$390.00

Service Code	HCPCS 86885
Hospital Charge Code	3100427
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INDIRECT COOMBS

Facility

$390.00

Service Code	HCPCS 86885
Hospital Charge Code	3100427
Hospital Revenue Code	300
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Medicare Advantage	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.96
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$2.86
Rate for Payer: Clover Medicare Advantage	$5.43
Rate for Payer: EmblemHealth Commercial	$17.16
Rate for Payer: Humana Medicare Advantage	$5.89
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	$5.72
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.06
Rate for Payer: Wellcare Medicare Advantage	$5.72

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84509005
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84517005
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84511005
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84509005
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84517005
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84518005
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84518005
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INDIVID NON MD 20-30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84511005
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84517009
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$427.14
Rate for Payer: Aetna Commercial	$427.14
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84509009
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84511009
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$427.14
Rate for Payer: Aetna Commercial	$427.14
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84509009
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$427.14
Rate for Payer: Aetna Commercial	$427.14
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84511009
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84518009
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$427.14
Rate for Payer: Aetna Commercial	$427.14
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84518009
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

INDIVID NON MD 45-50 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	84517009
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

INDIVIDUAL DX SESSION 1 HR****

Facility

$131.00

Service Code	HCPCS 90801
Hospital Charge Code	9300039
Hospital Revenue Code	910
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

INDIVIDUAL DX SESSION 1 HR****

Facility

$131.00

Service Code	HCPCS 90801
Hospital Charge Code	9300039
Hospital Revenue Code	910
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

INDIVIDUAL MEDS MANAGEMENT

Facility

$446.00

Service Code	HCPCS 90862
Hospital Charge Code	83246020
Hospital Revenue Code	910
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

INDIVIDUAL MEDS MANAGEMENT

Facility

$446.00

Service Code	HCPCS 90862
Hospital Charge Code	83246020
Hospital Revenue Code	910
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

INDIVIDUAL SESSION*****

Facility

$220.00

Service Code	HCPCS 90804
Hospital Charge Code	9310020
Hospital Revenue Code	914
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

INDIVIDUAL SESSION*****

Facility

$220.00

Service Code	HCPCS 90804
Hospital Charge Code	9310020
Hospital Revenue Code	914
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

Know your out-of-pocket cost for care.

All Charges