Heights University Hospital

All Charges

Charge

Type

Setting

Price

INFANT FORMULA SOY DIARRHEA

Facility

$17.00

Hospital Charge Code	60628824
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

INFANT FORMULA SOY DIARRHEA

Facility

$17.00

Hospital Charge Code	60628824
Hospital Revenue Code	270
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.50

INFANT FORMULA W/ IRON

Facility

$3.75

Hospital Charge Code	60629106
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.12
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.49
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$1.88

INFANT FORMULA W/ IRON

Facility

$3.75

Hospital Charge Code	60629106
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

INFANT FORMULA W/ IRON 960ML

Facility

$104.00

Hospital Charge Code	60628744
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 W/ IRON 960ML

Facility

$104.00

Hospital Charge Code	60628744
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 W/ IRON 960ML

Facility

$16.20

Service Code	HCPCS B9998
Hospital Charge Code	600628744
Hospital Revenue Code	259
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.13
Rate for Payer: Cigna Commercial	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.43
Rate for Payer: UnitedHealthcare Commercial	$8.10

INFANT FORMULA W/ IRON 960ML

Facility

$16.20

Service Code	HCPCS B9998
Hospital Charge Code	600628744
Hospital Revenue Code	259
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.43

INFANT PROFILE***

Facility

$38.00

Service Code	HCPCS 80054
Hospital Charge Code	3003597
Hospital Revenue Code	301
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

INFANT PROFILE***

Facility

$38.00

Service Code	HCPCS 80054
Hospital Charge Code	3003597
Hospital Revenue Code	301
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

INF CONCONURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	395096368
Hospital Revenue Code	260
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF CONCONURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	395096368
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	3401042
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF CONCURRENT THERAPEUTIC

Facility

$111.00

Service Code	HCPCS 96368
Hospital Charge Code	73050930
Hospital Revenue Code	260
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$33.30
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.43
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	100129
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF CONCURRENT THERAPEUTIC

Facility

$335.00

Service Code	HCPCS 96368
Hospital Charge Code	270329882
Hospital Revenue Code	260
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	93500047
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	93500047
Hospital Revenue Code	260
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	73190101
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF CONCURRENT THERAPEUTIC

Facility

$111.00

Service Code	HCPCS 96368
Hospital Charge Code	73050930
Hospital Revenue Code	260
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

INF CONCURRENT THERAPEUTIC

Facility

$2,800.00

Service Code	HCPCS 96368
Hospital Charge Code	3401042
Hospital Revenue Code	260
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$840.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF CONCURRENT THERAPEUTIC

Facility

$145.60

Service Code	HCPCS 96368
Hospital Charge Code	8200518
Hospital Revenue Code	260
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$43.68
Rate for Payer: Aetna Medicare Advantage	$43.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.13
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.93
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.84
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF CONCURRENT THERAPEUTIC

Facility

$145.60

Service Code	HCPCS 96368
Hospital Charge Code	5700405
Hospital Revenue Code	450
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$21.84
Rate for Payer: Qualcare PPO/HMO/WC	$21.84

INF CONCURRENT THERAPEUTIC

Facility

$145.60

Service Code	HCPCS 96368
Hospital Charge Code	8200518
Hospital Revenue Code	260
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$21.84
Rate for Payer: Qualcare PPO/HMO/WC	$21.84

INF CONCURRENT THERAPEUTIC

Facility

$145.60

Service Code	HCPCS 96368
Hospital Charge Code	5700405
Hospital Revenue Code	450
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$43.68
Rate for Payer: Aetna Commercial	$43.68
Rate for Payer: Aetna Medicare Advantage	$43.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.13
Rate for Payer: Cigna Commercial	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.93
Rate for Payer: Qualcare PPO/HMO/WC	$21.84

Know your out-of-pocket cost for care.

All Charges