Heights University Hospital

All Charges

Charge

Type

Setting

Price

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74116053
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

IV D5W 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650209
Hospital Revenue Code	258
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

IV D5W 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650209
Hospital Revenue Code	258
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

IV D5W 50ML SINGLE

Facility

$7.95

Hospital Charge Code	270650210
Hospital Revenue Code	258
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

IV D5W 50ML SINGLE

Facility

$7.95

Hospital Charge Code	270650210
Hospital Revenue Code	258
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$2.38
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.03
Rate for Payer: Oxford Commercial	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Commercial	$3.98

IVERMECTIN 3 MG TAB

Facility

$37.39

Service Code	NDC 6003220
Hospital Charge Code	60630088
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna Commercial	$11.22
Rate for Payer: Aetna Medicare Advantage	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.53
Rate for Payer: Cigna Commercial	$18.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.86
Rate for Payer: Oxford Commercial	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.61
Rate for Payer: UnitedHealthcare Commercial	$18.70

IVERMECTIN 3 MG TAB

Facility

$37.39

Service Code	NDC 6003220
Hospital Charge Code	60630088
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

IV FAT EMULSION 10% 500ML

Facility

$64.00

Hospital Charge Code	6003123
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

IV FAT EMULSION 10% 500ML

Facility

$64.00

Hospital Charge Code	6003123
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

IV FAT EMULSION 20% 500ML

Facility

$125.45

Hospital Charge Code	6003131
Hospital Revenue Code	250
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$62.73
Rate for Payer: Aetna Commercial	$37.63
Rate for Payer: Aetna Medicare Advantage	$37.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.99
Rate for Payer: Cigna Commercial	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.31
Rate for Payer: Oxford Commercial	$62.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$62.73

IV FAT EMULSION 20% 500ML

Facility

$125.45

Hospital Charge Code	6003131
Hospital Revenue Code	250
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

IV HALF SET (SIEMENS) *******

Facility

$10.00

Hospital Charge Code	8003550
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

IV HALF SET (SIEMENS) *******

Facility

$10.00

Hospital Charge Code	8003550
Hospital Revenue Code	272
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

IV HYDRA 16-90 EA ADD VAS

Facility

$1,326.52

Service Code	HCPCS 9636059
Hospital Charge Code	93500009
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

IV HYDRA 16-90 EA ADD VAS

Facility

$1,326.52

Service Code	HCPCS 9636059
Hospital Charge Code	93500009
Hospital Revenue Code	260
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$397.96
Rate for Payer: Aetna Medicare Advantage	$397.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.26
Rate for Payer: Cigna Commercial	$663.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.45
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.98
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV HYDRA 16-90MIN-INITIAL

Facility

$1,326.52

Service Code	HCPCS 96360
Hospital Charge Code	93500005
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

IV HYDRA 16-90MIN-INITIAL

Facility

$1,326.52

Service Code	HCPCS 96360
Hospital Charge Code	93500005
Hospital Revenue Code	260
Min. Negotiated Rate	$162.15
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$397.96
Rate for Payer: Aetna Medicare Advantage	$397.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.26
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.45
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.98
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV HYDRA 31-90 INITL AVS

Facility

$1,326.52

Service Code	HCPCS 9636059
Hospital Charge Code	93500011
Hospital Revenue Code	260
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$397.96
Rate for Payer: Aetna Medicare Advantage	$397.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.26
Rate for Payer: Cigna Commercial	$663.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.45
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.98
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV HYDRA 31-90 INITL AVS

Facility

$1,326.52

Service Code	HCPCS 9636059
Hospital Charge Code	93500011
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

IV INF 1STMED16-90 INI1VS

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500021
Hospital Revenue Code	260
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$421.73
Rate for Payer: Aetna Medicare Advantage	$421.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.47
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.75
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV INF 1STMED16-90 INI1VS

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500021
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INF 1STMED16-90 INIAVS

Facility

$1,405.77

Service Code	HCPCS 9636559
Hospital Charge Code	93500033
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INF 1STMED16-90 INIAVS

Facility

$1,405.77

Service Code	HCPCS 9636559
Hospital Charge Code	93500033
Hospital Revenue Code	260
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$421.73
Rate for Payer: Aetna Medicare Advantage	$421.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.47
Rate for Payer: Cigna Commercial	$702.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.75
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV INF IMMUNO-GLOBU 20GM

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500023
Hospital Revenue Code	260
Min. Negotiated Rate	$210.87
Max. Negotiated Rate	$210.87
Rate for Payer: Qualcare PPO/HMO/WC	$210.87

IV INF IMMUNO-GLOBU 20GM

Facility

$1,405.77

Service Code	HCPCS 96365
Hospital Charge Code	93500023
Hospital Revenue Code	260
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$421.73
Rate for Payer: Aetna Medicare Advantage	$421.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.47
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.75
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.87
Rate for Payer: UnitedHealthcare Commercial	$802.00

Know your out-of-pocket cost for care.

All Charges