Heights University Hospital

All Charges

Charge

Type

Setting

Price

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	3401028
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	3401031
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$221.80

Service Code	HCPCS 96366
Hospital Charge Code	321096366
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$66.54
Rate for Payer: Aetna Medicare Advantage	$66.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.56
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.83
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.27
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAPEUTIC EA ADDL HR

Facility

$598.74

Service Code	HCPCS 96366
Hospital Charge Code	5700376
Hospital Revenue Code	450
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$179.62
Rate for Payer: Aetna Commercial	$179.62
Rate for Payer: Aetna Medicare Advantage	$179.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.68
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.84
Rate for Payer: Qualcare PPO/HMO/WC	$89.81

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	270339104
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	1001176
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	411096366
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$99.56
Rate for Payer: Aetna Medicare Advantage	$99.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.63
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	270329881
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	1600531
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$99.56
Rate for Payer: Aetna Medicare Advantage	$99.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.63
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	3401029
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$99.56
Rate for Payer: Aetna Medicare Advantage	$99.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.63
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	395096366
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	100120
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$99.56
Rate for Payer: Aetna Medicare Advantage	$99.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.63
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$802.00

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	3401030
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

INF THERAPEUTIC EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96366
Hospital Charge Code	3401027
Hospital Revenue Code	260
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$99.56
Rate for Payer: Aetna Medicare Advantage	$99.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.63
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$802.00

INFUMORPH 25MG/ML 20ML

Facility

$41.00

Hospital Charge Code	60635370
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

INFUMORPH 25MG/ML 20ML

Facility

$41.00

Hospital Charge Code	60635370
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$20.50
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$20.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$20.50

INFUSE BONE GFT KIT MEDIUM

Facility

$22,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270630534
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

INFUSE BONE GFT KIT MEDIUM

Facility

$22,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270630534
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$6,600.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

INFUSE BONE GRAFT

Facility

$9,525.00

Service Code	HCPCS C1889
Hospital Charge Code	270652417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.75
Max. Negotiated Rate	$2,305.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,305.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,428.75

INFUSE BONE GRAFT

Facility

$9,525.00

Service Code	HCPCS C1889
Hospital Charge Code	270652417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.75
Max. Negotiated Rate	$4,762.50
Rate for Payer: Aetna Commercial	$2,857.50
Rate for Payer: Aetna Medicare Advantage	$2,857.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,428.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,428.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,428.88
Rate for Payer: Cigna Commercial	$4,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,305.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,428.75

INFUSE BONE GRAFT KIT LARGE

Facility

$30,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270670495
Hospital Revenue Code	278
Min. Negotiated Rate	$4,560.00
Max. Negotiated Rate	$15,200.00
Rate for Payer: Aetna Commercial	$9,120.00
Rate for Payer: Aetna Medicare Advantage	$9,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,752.00
Rate for Payer: Cigna Commercial	$15,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00

INFUSE BONE GRAFT KIT LARGE

Facility

$30,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270670495
Hospital Revenue Code	278
Min. Negotiated Rate	$4,560.00
Max. Negotiated Rate	$7,356.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00

INFUSION FOR THROMBOLYSIS

Facility

$382.20

Service Code	HCPCS 37201
Hospital Charge Code	5100541
Hospital Revenue Code	361
Min. Negotiated Rate	$49.69
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$114.66
Rate for Payer: Aetna Medicare Advantage	$114.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.46
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	$97.46
Rate for Payer: Cigna Commercial	$191.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.69
Rate for Payer: Qualcare PPO/HMO/WC	$57.33

INFUSION FOR THROMBOLYSIS

Facility

$382.20

Service Code	HCPCS 37201
Hospital Charge Code	5100541
Hospital Revenue Code	361
Min. Negotiated Rate	$57.33
Max. Negotiated Rate	$57.33
Rate for Payer: Qualcare PPO/HMO/WC	$57.33

INFUSION FOR THROMBOLYSIS S&I

Facility

$2,399.00

Service Code	HCPCS 75896
Hospital Charge Code	5100540
Hospital Revenue Code	320
Min. Negotiated Rate	$311.87
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$719.70
Rate for Payer: Aetna Medicare Advantage	$719.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$611.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$611.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$611.75
Rate for Payer: Cigna Commercial	$1,199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.87
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$359.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges