Heights University Hospital

All Charges

Charge

Type

Setting

Price

INF THERAP DIFF DRUG 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	74308245
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	73237023
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	$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	$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	3401041
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	73190099
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	270339105
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

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	73237023
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

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	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	270339105
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

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	8200517
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	3401041
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	$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

$2,145.09

Service Code	HCPCS 96367
Hospital Charge Code	5700404
Hospital Revenue Code	450
Min. Negotiated Rate	$321.76
Max. Negotiated Rate	$321.76
Rate for Payer: Qualcare PPO/HMO/WC	$321.76

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	83653140
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	3401070
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

$1,334.09

Service Code	HCPCS 96367
Hospital Charge Code	74308245
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	83653140
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

$2,145.09

Service Code	HCPCS 96367
Hospital Charge Code	5700404
Hospital Revenue Code	450
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$643.53
Rate for Payer: Aetna Commercial	$643.53
Rate for Payer: Aetna Medicare Advantage	$643.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$547.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$547.00
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	$547.00
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.86
Rate for Payer: Qualcare PPO/HMO/WC	$321.76

INF THERAP DIFF DRUG 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96367
Hospital Charge Code	73190099
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 THERAPEUTIC 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96365
Hospital Charge Code	5700259
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INF THERAPEUTIC 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96365
Hospital Charge Code	411096365
Hospital Revenue Code	260
Min. Negotiated Rate	$42.85
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	$42.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$506.53
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 THERAPEUTIC 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96365
Hospital Charge Code	270329880
Hospital Revenue Code	260
Min. Negotiated Rate	$42.85
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	$42.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.19
Rate for Payer: Cigna Commercial	$506.53
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 THERAPEUTIC 1ST HR

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	73050970
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

INF THERAPEUTIC 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96365
Hospital Charge Code	93082001
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

Know your out-of-pocket cost for care.

All Charges