Heights University Hospital

All Charges

Charge

Type

Setting

Price

INHIBIN B

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3038149
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

INHIBIN B

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3038149
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

INHIBIN B

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	39900439
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INHIBIN B

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	39900439
Hospital Revenue Code	301
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.75
Rate for Payer: Aetna Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.74
Rate for Payer: Cigna Commercial	$14.12
Rate for Payer: Cigna Medicare Advantage	$7.06
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.97
Rate for Payer: Wellcare Medicare Advantage	$14.12

INITIAL ASSESSMENT BY SW

Facility

$449.95

Service Code	HCPCS 90801
Hospital Charge Code	9310085
Hospital Revenue Code	900
Min. Negotiated Rate	$58.49
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$134.99
Rate for Payer: Aetna Medicare Advantage	$134.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.74
Rate for Payer: Cigna Commercial	$224.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.49
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.49
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

INITIAL ASSESSMENT BY SW

Facility

$449.95

Service Code	HCPCS 90801
Hospital Charge Code	9310085
Hospital Revenue Code	900
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$67.49
Rate for Payer: Qualcare PPO/HMO/WC	$67.49

INITIAL DX ASSESSMENT*****

Facility

$240.00

Service Code	HCPCS 90801
Hospital Charge Code	9310012
Hospital Revenue Code	910
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

INITIAL DX ASSESSMENT*****

Facility

$240.00

Service Code	HCPCS 90801
Hospital Charge Code	9310012
Hospital Revenue Code	910
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

INITIAL MEDICAL VISIT WHC****

Facility

$49.50

Service Code	HCPCS 99203WF
Hospital Charge Code	9600011
Hospital Revenue Code	519
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$7.42
Rate for Payer: Qualcare PPO/HMO/WC	$7.42

INITIAL MEDICAL VISIT WHC****

Facility

$49.50

Service Code	HCPCS 99203WF
Hospital Charge Code	9600011
Hospital Revenue Code	519
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: Aetna Medicare Advantage	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.62
Rate for Payer: Cigna Commercial	$24.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.42

INITIAL PREVENTIVE PHY EXAM GE

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502820
Hospital Revenue Code	770
Min. Negotiated Rate	$65.06
Max. Negotiated Rate	$317.04
Rate for Payer: Aetna Commercial	$150.13
Rate for Payer: Aetna Medicare Advantage	$150.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.61
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.06
Rate for Payer: Oxford Commercial	$250.22
Rate for Payer: Qualcare PPO/HMO/WC	$75.07
Rate for Payer: UnitedHealthcare Commercial	$250.22

INITIAL PREVENTIVE PHY EXAM GE

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502820
Hospital Revenue Code	770
Min. Negotiated Rate	$75.07
Max. Negotiated Rate	$75.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.07

INJ/AIR/CONT INTO PERITONEAL

Facility

$509.70

Service Code	HCPCS 49400
Hospital Charge Code	1600000353
Hospital Revenue Code	360
Min. Negotiated Rate	$66.26
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$152.91
Rate for Payer: Aetna Medicare Advantage	$152.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.97
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	$129.97
Rate for Payer: Cigna Commercial	$84.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.26
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.45
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ/AIR/CONT INTO PERITONEAL

Facility

$509.70

Service Code	HCPCS 49400
Hospital Charge Code	1600000353
Hospital Revenue Code	360
Min. Negotiated Rate	$76.45
Max. Negotiated Rate	$76.45
Rate for Payer: Qualcare PPO/HMO/WC	$76.45

INJ ANESTH,PUDENDAL NERVE

Facility

$7,956.80

Service Code	HCPCS 64430
Hospital Charge Code	16001032
Hospital Revenue Code	360
Min. Negotiated Rate	$1,034.38
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$2,387.04
Rate for Payer: Aetna Medicare Advantage	$2,387.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,028.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,028.98
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	$2,028.98
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ ANESTH,PUDENDAL NERVE

Facility

$7,956.80

Service Code	HCPCS 64430
Hospital Charge Code	16001032
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ ANESTH,STELLATE GANGLION

Facility

$3,152.73

Service Code	HCPCS 64510
Hospital Charge Code	16001039
Hospital Revenue Code	360
Min. Negotiated Rate	$409.85
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$945.82
Rate for Payer: Aetna Medicare Advantage	$945.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.95
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	$803.95
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.85
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ ANESTH,STELLATE GANGLION

Facility

$3,152.73

Service Code	HCPCS 64510
Hospital Charge Code	16001039
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ ANSTH,LUMB/THORSYMPATHETIC

Facility

$3,152.73

Service Code	HCPCS 64520
Hospital Charge Code	16000434
Hospital Revenue Code	360
Min. Negotiated Rate	$409.85
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$945.82
Rate for Payer: Aetna Medicare Advantage	$945.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.95
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	$803.95
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.85
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ ANSTH,LUMB/THORSYMPATHETIC

Facility

$3,152.73

Service Code	HCPCS 64520
Hospital Charge Code	16000434
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ ANSTH-PERIPHERL NRV/BRANCH

Facility

$4,414.73

Service Code	HCPCS 64450
Hospital Charge Code	1600000416
Hospital Revenue Code	360
Min. Negotiated Rate	$662.21
Max. Negotiated Rate	$662.21
Rate for Payer: Qualcare PPO/HMO/WC	$662.21

INJ ANSTH-PERIPHERL NRV/BRANCH

Facility

$4,414.73

Service Code	HCPCS 64450
Hospital Charge Code	1600000416
Hospital Revenue Code	360
Min. Negotiated Rate	$573.91
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,324.42
Rate for Payer: Aetna Medicare Advantage	$1,324.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,125.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,125.76
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	$1,125.76
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$573.91
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$662.21
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJ ARIPIPRAZOLE ER 300 MG

Facility

$9,554.27

Service Code	HCPCS J0401
Hospital Charge Code	6063943338
Hospital Revenue Code	636
Min. Negotiated Rate	$1,433.14
Max. Negotiated Rate	$2,312.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,312.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.14

INJ ARIPIPRAZOLE ER 300 MG

Facility

$9,554.27

Service Code	HCPCS J0401
Hospital Charge Code	6063943338
Hospital Revenue Code	636
Min. Negotiated Rate	$1,433.14
Max. Negotiated Rate	$2,866.28
Rate for Payer: Aetna Commercial	$2,866.28
Rate for Payer: Aetna Medicare Advantage	$2,866.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,436.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,436.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,436.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,312.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.14

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges