Heights University Hospital

All Charges

Charge

Type

Setting

Price

INDOMETHACIN CAP 25MG

Facility

$1.95

Hospital Charge Code	6022578
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

INDOMETHACIN CAP 25MG

Facility

$1.95

Hospital Charge Code	6022578
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

INDOMETHACIN CAP 50MG

Facility

$5.80

Hospital Charge Code	60627685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

INDOMETHACIN CAP 50MG

Facility

$5.80

Hospital Charge Code	60627685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

INDOMETHACIN CAP SR 75MG

Facility

$10.90

Hospital Charge Code	6009690
Hospital Revenue Code	252
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

INDOMETHACIN CAP SR 75MG

Facility

$10.90

Hospital Charge Code	6009690
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

INDOMETHACIN SUPP 30MG

Facility

$10.90

Hospital Charge Code	6009682
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

INDOMETHACIN SUPP 30MG

Facility

$10.90

Hospital Charge Code	6009682
Hospital Revenue Code	252
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

INDOMETHACIN SUPP 50MG

Facility

$18.45

Hospital Charge Code	60627686
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

INDOMETHACIN SUPP 50MG

Facility

$18.45

Hospital Charge Code	60627686
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$9.22

IND PSYCHOTHERAPY 60 MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	4546744
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

IND PSYCHOTHERAPY 60 MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	4546744
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

IND PSYCHOTHERAPY NON MD 30MIN

Facility

$750.00

Service Code	HCPCS 90832
Hospital Charge Code	4546763
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
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	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
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	$71.39

IND PSYCHOTHERAPY NON MD 30MIN

Facility

$750.00

Service Code	HCPCS 90832
Hospital Charge Code	4546763
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

IND PSYCHOTHERAPY NONMD 30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	4546742
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

IND PSYCHOTHERAPY NONMD 30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	4546742
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

IND PSYCHOTHERAPY NONMD 30MIN

Facility

$750.00

Service Code	HCPCS 90832
Hospital Charge Code	4546769
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

IND PSYCHOTHERAPY NONMD 30MIN

Facility

$750.00

Service Code	HCPCS 90832
Hospital Charge Code	4546769
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
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	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
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	$71.39

IND PSYCHOTHERAPY NON MD 40MIN

Facility

$1,500.00

Service Code	HCPCS 90834
Hospital Charge Code	4546770
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
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	$150.25
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

IND PSYCHOTHERAPY NON MD 40MIN

Facility

$1,500.00

Service Code	HCPCS 90834
Hospital Charge Code	4546770
Hospital Revenue Code	914
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

IND PSYCHOTHERAPY NONMD 45 MIN

Facility

$1,423.00

Service Code	HCPCS 90834
Hospital Charge Code	4646750
Hospital Revenue Code	914
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$426.90
Rate for Payer: Aetna Commercial	$426.90
Rate for Payer: Aetna Medicare Advantage	$426.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.87
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	$362.87
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.99
Rate for Payer: Qualcare PPO/HMO/WC	$213.45
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

IND PSYCHOTHERAPY NONMD 45 MIN

Facility

$1,423.00

Service Code	HCPCS 90834
Hospital Charge Code	4646750
Hospital Revenue Code	914
Min. Negotiated Rate	$213.45
Max. Negotiated Rate	$213.45
Rate for Payer: Qualcare PPO/HMO/WC	$213.45

IND PSYCHOTHERAPY NON MD 60MIN

Facility

$2,000.00

Service Code	HCPCS 2000
Hospital Charge Code	4546771
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

IND PSYCHOTHERAPY NON MD 60MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	4546751
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

IND PSYCHOTHERAPY NON MD 60MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	4546751
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges