Heights University Hospital

All Charges

Charge

Type

Setting

Price

INFLUENZA VIRUS VACCINE-PEDS

Facility

$35.20

Service Code	HCPCS 90657
Hospital Charge Code	60628910
Hospital Revenue Code	636
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$28.11
Rate for Payer: Aetna Commercial	$10.56
Rate for Payer: Aetna Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.98
Rate for Payer: Cigna Commercial	$11.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$5.28

INFLU PCR RFX

Facility

$704.70

Service Code	HCPCS 87502
Hospital Charge Code	3036001EX
Hospital Revenue Code	306
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$351.01
Rate for Payer: Aetna Commercial	$310.39
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.01
Rate for Payer: Cigna Commercial	$95.80
Rate for Payer: Cigna Medicare Advantage	$47.90
Rate for Payer: Clover Medicare Advantage	$91.01
Rate for Payer: EmblemHealth Commercial	$287.40
Rate for Payer: Humana Medicare Advantage	$98.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$101.55
Rate for Payer: Wellcare Medicare Advantage	$95.80

INFLU PCR RFX

Facility

$704.70

Service Code	HCPCS 87502
Hospital Charge Code	3036001EX
Hospital Revenue Code	306
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$105.70
Rate for Payer: Qualcare PPO/HMO/WC	$105.70

INFLU PCR RFX 1

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001A
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	$33.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
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

INFLU PCR RFX 1

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001A
Hospital Revenue Code	306
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

INFLU PCR RFX 2

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001B
Hospital Revenue Code	306
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

INFLU PCR RFX 2

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3036001B
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	$33.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
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

INFLUX DEMIN CORTICAL BONE FIB

Facility

$1,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270703817
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$932.50
Rate for Payer: Aetna Commercial	$559.50
Rate for Payer: Aetna Medicare Advantage	$559.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$475.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$475.57
Rate for Payer: Cigna Commercial	$932.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

INFLUX DEMIN CORTICAL BONE FIB

Facility

$1,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270703817
Hospital Revenue Code	278
Min. Negotiated Rate	$279.75
Max. Negotiated Rate	$451.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.33
Rate for Payer: Qualcare PPO/HMO/WC	$279.75

INFLUX DEMINERALIZED CORTICAL

Facility

$6,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270703847
Hospital Revenue Code	278
Min. Negotiated Rate	$964.50
Max. Negotiated Rate	$1,556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.06
Rate for Payer: Qualcare PPO/HMO/WC	$964.50

INFLUX DEMINERALIZED CORTICAL

Facility

$6,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270703847
Hospital Revenue Code	278
Min. Negotiated Rate	$964.50
Max. Negotiated Rate	$3,215.00
Rate for Payer: Aetna Commercial	$1,929.00
Rate for Payer: Aetna Medicare Advantage	$1,929.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.65
Rate for Payer: Cigna Commercial	$3,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.06
Rate for Payer: Qualcare PPO/HMO/WC	$964.50

INFLUX DEMINERALIZED CORTICAL

Facility

$910.00

Hospital Charge Code	270703472
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$220.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

INFLUX DEMINERALIZED CORTICAL

Facility

$910.00

Hospital Charge Code	270703472
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$273.00
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

INFLUX PROTEIOS XL

Facility

$14,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270704461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,208.75
Max. Negotiated Rate	$3,563.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,563.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,208.75

INFLUX PROTEIOS XL

Facility

$14,725.00

Service Code	HCPCS C1889
Hospital Charge Code	270704461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,208.75
Max. Negotiated Rate	$7,362.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$4,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,754.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,754.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,754.88
Rate for Payer: Cigna Commercial	$7,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,563.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,208.75

INFLUX SPARC 10CC

Facility

$17,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270705826
Hospital Revenue Code	279
Min. Negotiated Rate	$2,307.50
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$5,325.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.50
Rate for Payer: Oxford Commercial	$8,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Commercial	$8,875.00

INFLUX SPARC 10CC

Facility

$17,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270705826
Hospital Revenue Code	279
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$2,662.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

INFLUX SPARC 5CC

Facility

$9,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270705849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$2,925.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

INFLUX SPARC 5CC

Facility

$9,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270705849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

INF THERAP DIFF DRUG 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	73050925
Hospital Revenue Code	260
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$400.23
Rate for Payer: Aetna Medicare Advantage	$400.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.19
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.43
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAP DIFF DRUG 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	8200517
Hospital Revenue Code	260
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$400.23
Rate for Payer: Aetna Medicare Advantage	$400.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.19
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.43
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	100128
Hospital Revenue Code	260
Min. Negotiated Rate	$20.70
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	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$171.47
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 THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	395096367
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	93500045
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	3401070
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

Know your out-of-pocket cost for care.

All Charges