Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJECTION IM/SUBQ

Facility

$206.86

Service Code	HCPCS 96372
Hospital Charge Code	36540003
Hospital Revenue Code	260
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$31.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.03

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	93500055
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	73190103
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
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	$13.49
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

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	73050975
Hospital Revenue Code	260
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4822524
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$840.00
Rate for Payer: Oxford Commercial	$707.00
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	$13.49
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: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$802.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	73237024
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
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	$13.49
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

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4824524
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$320.48

Service Code	HCPCS 96372
Hospital Charge Code	5700254
Hospital Revenue Code	260
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$48.07
Rate for Payer: Qualcare PPO/HMO/WC	$48.07

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	93500055
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$102.90
Rate for Payer: Aetna Medicare Advantage	$102.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.47
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.59
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$802.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	74308250
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
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	$13.49
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

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	84310135
Hospital Revenue Code	510
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$171.47
Rate for Payer: Aetna Commercial	$103.52
Rate for Payer: Aetna Medicare Advantage	$103.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.99
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.86
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	74308250
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$320.48

Service Code	HCPCS 96372
Hospital Charge Code	1500103
Hospital Revenue Code	260
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$48.07
Rate for Payer: Qualcare PPO/HMO/WC	$48.07

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	73190103
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4509524
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$343.00

Service Code	HCPCS 96372
Hospital Charge Code	3400256M
Hospital Revenue Code	260
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$102.90
Rate for Payer: Aetna Medicare Advantage	$102.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.47
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.59
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$802.00

INJECTION SYRINGE

Facility

$3,350.00

Hospital Charge Code	270659099
Hospital Revenue Code	278
Min. Negotiated Rate	$502.50
Max. Negotiated Rate	$1,675.00
Rate for Payer: Aetna Commercial	$1,005.00
Rate for Payer: Aetna Medicare Advantage	$1,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.25
Rate for Payer: Cigna Commercial	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$502.50

INJECTION SYRINGE

Facility

$3,350.00

Hospital Charge Code	270659099
Hospital Revenue Code	278
Min. Negotiated Rate	$502.50
Max. Negotiated Rate	$810.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$502.50

INJECTION TENDON ORIGIN

Facility

$1,449.20

Service Code	HCPCS 20551
Hospital Charge Code	412320551
Hospital Revenue Code	510
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$434.76
Rate for Payer: Aetna Medicare Advantage	$434.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.55
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.40
Rate for Payer: Qualcare PPO/HMO/WC	$217.38

INJECTION TENDON ORIGIN

Facility

$1,449.20

Service Code	HCPCS 20551
Hospital Charge Code	412320551
Hospital Revenue Code	510
Min. Negotiated Rate	$217.38
Max. Negotiated Rate	$217.38
Rate for Payer: Qualcare PPO/HMO/WC	$217.38

INJECTION THERAPY OF VEIN

Facility

$2,127.90

Service Code	HCPCS 36470
Hospital Charge Code	421036470
Hospital Revenue Code	761
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$1,063.95
Rate for Payer: Aetna Commercial	$638.37
Rate for Payer: Aetna Medicare Advantage	$638.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$542.61
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.63
Rate for Payer: Oxford Commercial	$1,063.95
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$1,063.95

INJECTION THERAPY OF VEIN

Facility

$2,127.90

Service Code	HCPCS 36470
Hospital Charge Code	421036470
Hospital Revenue Code	761
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

INJECTION THERAPY OF VEINS

Facility

$2,127.90

Service Code	HCPCS 36471
Hospital Charge Code	421036471
Hospital Revenue Code	761
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

INJECTION THERAPY OF VEINS

Facility

$2,127.90

Service Code	HCPCS 36471
Hospital Charge Code	421036471
Hospital Revenue Code	761
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$1,063.95
Rate for Payer: Aetna Commercial	$638.37
Rate for Payer: Aetna Medicare Advantage	$638.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.61
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	$542.61
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.63
Rate for Payer: Oxford Commercial	$1,063.95
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$1,063.95

INJECTION THERAPY OF VEINS

Facility

$1,243.20

Service Code	HCPCS 36471
Hospital Charge Code	1600000779
Hospital Revenue Code	360
Min. Negotiated Rate	$161.62
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$372.96
Rate for Payer: Aetna Medicare Advantage	$372.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$317.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$317.02
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	$317.02
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.48
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges