Heights University Hospital

All Charges

Charge

Type

Setting

Price

INFUSION FOR THROMBOLYSIS S&I

Facility

$2,399.00

Service Code	HCPCS 75896
Hospital Charge Code	5100540
Hospital Revenue Code	320
Min. Negotiated Rate	$359.85
Max. Negotiated Rate	$359.85
Rate for Payer: Qualcare PPO/HMO/WC	$359.85

INFUSION PORT 8FR POL SIL SGL

Facility

$10,636.80

Service Code	HCPCS C1788
Hospital Charge Code	270701578
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.52
Max. Negotiated Rate	$5,318.40
Rate for Payer: Aetna Commercial	$3,191.04
Rate for Payer: Aetna Medicare Advantage	$3,191.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,712.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,712.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,712.38
Rate for Payer: Cigna Commercial	$5,318.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.52

INFUSION PORT 8FR POL SIL SGL

Facility

$10,636.80

Service Code	HCPCS C1788
Hospital Charge Code	270701578
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.52
Max. Negotiated Rate	$2,574.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.52

INFUSION SET EZ HUBER 20g 3/4

Facility

$31.50

Hospital Charge Code	270642543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$4.72
Rate for Payer: Qualcare PPO/HMO/WC	$4.72

INFUSION SET EZ HUBER 20g 3/4

Facility

$31.50

Hospital Charge Code	270642543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$9.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.03
Rate for Payer: Cigna Commercial	$15.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.72
Rate for Payer: UnitedHealthcare Commercial	$15.75

INFUSION SET PRIMARY SAPPHIRE

Facility

$54.80

Hospital Charge Code	270675461
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$27.40
Rate for Payer: Aetna Commercial	$16.44
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.97
Rate for Payer: Cigna Commercial	$27.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.12
Rate for Payer: Oxford Commercial	$27.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.22
Rate for Payer: UnitedHealthcare Commercial	$27.40

INFUSION SET PRIMARY SAPPHIRE

Facility

$54.80

Hospital Charge Code	270675461
Hospital Revenue Code	272
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$8.22

INFUSION THERAPY 0-1 HR***

Facility

$135.00

Hospital Charge Code	3401011
Hospital Revenue Code	289
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

INFUSION THERAPY 0-1 HR***

Facility

$135.00

Hospital Charge Code	3401011
Hospital Revenue Code	289
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

INFUSION THERAPY 1-2 HRS****

Facility

$179.00

Hospital Charge Code	3401012
Hospital Revenue Code	289
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$53.70
Rate for Payer: Aetna Medicare Advantage	$53.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.27
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

INFUSION THERAPY 1-2 HRS****

Facility

$179.00

Hospital Charge Code	3401012
Hospital Revenue Code	289
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

INFUSION THERAPY 2-4 HRS***

Facility

$211.00

Hospital Charge Code	3401014
Hospital Revenue Code	289
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

INFUSION THERAPY 2-4 HRS***

Facility

$211.00

Hospital Charge Code	3401014
Hospital Revenue Code	289
Min. Negotiated Rate	$27.43
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$63.30
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.43
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

INFUSION THERAPY 4-6 HRS****

Facility

$243.00

Hospital Charge Code	3401015
Hospital Revenue Code	289
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$36.45
Rate for Payer: Qualcare PPO/HMO/WC	$36.45

INFUSION THERAPY 4-6 HRS****

Facility

$243.00

Hospital Charge Code	3401015
Hospital Revenue Code	289
Min. Negotiated Rate	$31.59
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$72.90
Rate for Payer: Aetna Medicare Advantage	$72.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.97
Rate for Payer: Cigna Commercial	$121.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.59
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.45
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

INFUSION THERAPY 6-8 HRS****

Facility

$287.00

Hospital Charge Code	3401016
Hospital Revenue Code	289
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

INFUSION THERAPY 6-8 HRS****

Facility

$287.00

Hospital Charge Code	3401016
Hospital Revenue Code	289
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$1,805.00
Rate for Payer: Aetna Commercial	$86.10
Rate for Payer: Aetna Medicare Advantage	$86.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.19
Rate for Payer: Cigna Commercial	$143.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.31
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.05
Rate for Payer: UnitedHealthcare Commercial	$1,805.00

INFUSION THER/DIAG CONCURRENT

Facility

$116.48

Service Code	HCPCS 90768
Hospital Charge Code	3401075
Hospital Revenue Code	260
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$34.94
Rate for Payer: Aetna Medicare Advantage	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.70
Rate for Payer: Cigna Commercial	$58.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.14
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Commercial	$802.00

INFUSION THER/DIAG CONCURRENT

Facility

$116.48

Service Code	HCPCS 90768
Hospital Charge Code	3401075
Hospital Revenue Code	260
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

INFUS KIT 5.2FR 30cm 500-52130

Facility

$12,475.00

Hospital Charge Code	270637509V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$6,237.50
Rate for Payer: Aetna Commercial	$3,742.50
Rate for Payer: Aetna Medicare Advantage	$3,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,181.12
Rate for Payer: Cigna Commercial	$6,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

INFUS KIT 5.2FR 30cm 500-52130

Facility

$12,475.00

Hospital Charge Code	270637509V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$3,018.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

INFUS KIT 5.2FR 40cm 500-52140

Facility

$12,475.00

Hospital Charge Code	270637510V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$3,018.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

INFUS KIT 5.2FR 40cm 500-52140

Facility

$12,475.00

Hospital Charge Code	270637510V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$6,237.50
Rate for Payer: Aetna Commercial	$3,742.50
Rate for Payer: Aetna Medicare Advantage	$3,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,181.12
Rate for Payer: Cigna Commercial	$6,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

INFUS KIT 5.2FR 50cm 500-52150

Facility

$11,975.00

Hospital Charge Code	270637511V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

INFUS KIT 5.2FR 50cm 500-52150

Facility

$11,975.00

Hospital Charge Code	270637511V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

Know your out-of-pocket cost for care.

All Charges