Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJ PARAVERT F JNT C/T 2 LEV

Facility

$7,956.80

Service Code	HCPCS 64491
Hospital Charge Code	16000654
Hospital Revenue Code	360
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$2,387.04
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	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT C/T 2 LEV

Facility

$7,956.80

Service Code	HCPCS 64491
Hospital Charge Code	411064491
Hospital Revenue Code	361
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ PARAVERT F JNT C/T 2 LEV

Facility

$5,111.97

Service Code	HCPCS 64491
Hospital Charge Code	321564491
Hospital Revenue Code	361
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,533.59
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.56
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT C/T 3 LEV

Facility

$7,956.80

Service Code	HCPCS 64492
Hospital Charge Code	16000655
Hospital Revenue Code	360
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$2,387.04
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	$55.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT C/T 3 LEV

Facility

$7,956.80

Service Code	HCPCS 64492
Hospital Charge Code	16000655
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 PARAVERT F JNT C/T LEV

Facility

$7,956.80

Service Code	HCPCS 64490
Hospital Charge Code	411064490
Hospital Revenue Code	361
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ PARAVERT F JNT C/T LEV

Facility

$7,956.80

Service Code	HCPCS 64490
Hospital Charge Code	16000593
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 PARAVERT F JNT C/T LEV

Facility

$7,956.80

Service Code	HCPCS 64490
Hospital Charge Code	16000593
Hospital Revenue Code	360
Min. Negotiated Rate	$1,034.38
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT C/T LEV

Facility

$7,956.80

Service Code	HCPCS 64490
Hospital Charge Code	411064490
Hospital Revenue Code	361
Min. Negotiated Rate	$1,034.38
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT L/S 1 LEV

Facility

$5,111.97

Service Code	HCPCS 64493
Hospital Charge Code	321564493
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

INJ PARAVERT F JNT L/S 1 LEV

Facility

$6,666.60

Service Code	HCPCS 64493
Hospital Charge Code	411064493
Hospital Revenue Code	361
Min. Negotiated Rate	$866.66
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$1,999.98
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.66
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT L/S 1 LEV

Facility

$6,666.60

Service Code	HCPCS 64493
Hospital Charge Code	16001035
Hospital Revenue Code	360
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 1 LEV

Facility

$6,666.60

Service Code	HCPCS 64493
Hospital Charge Code	411064493
Hospital Revenue Code	361
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 1 LEV

Facility

$5,111.97

Service Code	HCPCS 64493
Hospital Charge Code	321564493
Hospital Revenue Code	361
Min. Negotiated Rate	$664.56
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$1,533.59
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT L/S 1 LEV

Facility

$6,666.60

Service Code	HCPCS 64493
Hospital Charge Code	16001035
Hospital Revenue Code	360
Min. Negotiated Rate	$866.66
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$1,999.98
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.66
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ PARAVERT F JNT L/S 2 LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	441064494
Hospital Revenue Code	361
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,999.98
Rate for Payer: Aetna Commercial	$1,999.98
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$47.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.66
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT L/S 2 LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	441064494
Hospital Revenue Code	361
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 2 LEV

Facility

$511.97

Service Code	HCPCS 64494
Hospital Charge Code	1600000737
Hospital Revenue Code	360
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$76.80
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

INJ PARAVERT F JNT L/S 2 LEV

Facility

$5,111.97

Service Code	HCPCS 64494
Hospital Charge Code	321564494
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

INJ PARAVERT F JNT L/S 2 LEV

Facility

$511.97

Service Code	HCPCS 64494
Hospital Charge Code	1600000737
Hospital Revenue Code	360
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$153.59
Rate for Payer: Aetna Medicare Advantage	$153.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.55
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	$130.55
Rate for Payer: Cigna Commercial	$47.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.56
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT L/S 2 LEV

Facility

$5,111.97

Service Code	HCPCS 64494
Hospital Charge Code	321564494
Hospital Revenue Code	361
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,533.59
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$47.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.56
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT L/S 2-LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	1600000430
Hospital Revenue Code	360
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,999.98
Rate for Payer: Aetna Commercial	$1,999.98
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$47.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.66
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT L/S 2-LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	1600000430
Hospital Revenue Code	360
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 3 LEV

Facility

$5,111.97

Service Code	HCPCS 64495
Hospital Charge Code	321564495
Hospital Revenue Code	361
Min. Negotiated Rate	$48.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,533.59
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$48.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.56
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ PARAVERT F JNT L/S 3 LEV

Facility

$5,111.97

Service Code	HCPCS 64495
Hospital Charge Code	321564495
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

Know your out-of-pocket cost for care.

All Charges