Heights University Hospital

All Charges

Charge

Type

Setting

Price

IND SESSION NON MD 30 MIN

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	87506100
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

IND SESSION NON MD 45 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	87506105
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

IND SESSION NON MD 45 MIN

Facility

$1,423.80

Service Code	HCPCS 90834
Hospital Charge Code	87506105
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

IND SESSION NON MD 60 MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	87506110
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 SESSION NON MD 60 MIN

Facility

$550.00

Service Code	HCPCS 90837
Hospital Charge Code	87506110
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

IND. THERAPY 75-80 MN

Facility

$671.00

Service Code	HCPCS 90808
Hospital Charge Code	84504030
Hospital Revenue Code	914
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

IND. THERAPY 75-80 MN

Facility

$671.00

Service Code	HCPCS 90808
Hospital Charge Code	84504030
Hospital Revenue Code	914
Min. Negotiated Rate	$87.23
Max. Negotiated Rate	$335.50
Rate for Payer: Aetna Commercial	$201.30
Rate for Payer: Aetna Medicare Advantage	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.10
Rate for Payer: Cigna Commercial	$335.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.23
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

INDUCED ABORTION BY D & C

Facility

$19,400.60

Service Code	HCPCS 59840
Hospital Charge Code	1600000826
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$5,820.18
Rate for Payer: Aetna Medicare Advantage	$5,820.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,947.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,947.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,947.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,522.08
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,910.09
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

INDUCED ABORTION BY D & C

Facility

$19,400.60

Service Code	HCPCS 59840
Hospital Charge Code	1600000826
Hospital Revenue Code	360
Min. Negotiated Rate	$2,910.09
Max. Negotiated Rate	$2,910.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,910.09

INDUX 14X50MM

Facility

$9,450.00

Hospital Charge Code	270656933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$2,835.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

INDUX 14X50MM

Facility

$9,450.00

Hospital Charge Code	270656933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

INF AGENT DETECT AMP PROB TECH

Facility

$248.54

Service Code	HCPCS 87798
Hospital Charge Code	38476308
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

INF AGENT DETECT AMP PROB TECH

Facility

$248.54

Service Code	HCPCS 87798
Hospital Charge Code	38476308
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

INFANT FORMULA

Facility

$104.00

Hospital Charge Code	60628848
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

INFANT FORMULA

Facility

$104.00

Hospital Charge Code	60628848
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

INFANT FORMULA

Facility

$104.00

Hospital Charge Code	60628800
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

INFANT FORMULA

Facility

$104.00

Hospital Charge Code	60628800
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

INFANT FORMULA 24CAL/02 NATURA

Facility

$104.00

Hospital Charge Code	60628855
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

INFANT FORMULA 24CAL/02 NATURA

Facility

$104.00

Hospital Charge Code	60628855
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

INFANT FORMULA 24CAL/02 SPEC

Facility

$104.00

Hospital Charge Code	60628856
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

INFANT FORMULA 24CAL/02 SPEC

Facility

$104.00

Hospital Charge Code	60628856
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

INFANT FORMULA 60 ML BTL

Facility

$30.00

Hospital Charge Code	60628938
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

INFANT FORMULA 60 ML BTL

Facility

$30.00

Hospital Charge Code	60628938
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

INFANT FORMULA HYPOALLER 960ML

Facility

$104.00

Hospital Charge Code	60628770
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

INFANT FORMULA HYPOALLER 960ML

Facility

$104.00

Hospital Charge Code	60628770
Hospital Revenue Code	270
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$52.00

Know your out-of-pocket cost for care.

All Charges