Heights University Hospital

All Charges

Charge

Type

Setting

Price

IVP

Facility

$1,255.00

Service Code	HCPCS 74400
Hospital Charge Code	94061149
Hospital Revenue Code	320
Min. Negotiated Rate	$86.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$376.50
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IVPB ODD DOSE =<1G

Facility

$93.45

Hospital Charge Code	60627259
Hospital Revenue Code	258
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$46.73
Rate for Payer: Aetna Commercial	$28.04
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.15
Rate for Payer: Oxford Commercial	$46.73
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$46.73

IVPB ODD DOSE =<1G

Facility

$93.45

Hospital Charge Code	60627259
Hospital Revenue Code	258
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

IV PREADMIN IMMUNOGLOBULIN

Facility

$259.30

Hospital Charge Code	3401108
Hospital Revenue Code	636
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$129.65
Rate for Payer: Aetna Commercial	$77.79
Rate for Payer: Aetna Medicare Advantage	$77.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.12
Rate for Payer: Cigna Commercial	$129.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.90

IV PREADMIN IMMUNOGLOBULIN

Facility

$259.30

Hospital Charge Code	3401108
Hospital Revenue Code	636
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$62.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.90

IV PUSH-1ST MED DUR INFUS

Facility

$465.14

Service Code	HCPCS 96375
Hospital Charge Code	93500071
Hospital Revenue Code	260
Min. Negotiated Rate	$60.47
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$139.54
Rate for Payer: Aetna Medicare Advantage	$139.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.61
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.47
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.77
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH-1ST MED DUR INFUS

Facility

$465.14

Service Code	HCPCS 96375
Hospital Charge Code	93500071
Hospital Revenue Code	260
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$69.77
Rate for Payer: Qualcare PPO/HMO/WC	$69.77

IV PUSH-1STMED INITAL AVS

Facility

$394.88

Service Code	HCPCS 9637459
Hospital Charge Code	93500067
Hospital Revenue Code	260
Min. Negotiated Rate	$51.33
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$118.46
Rate for Payer: Aetna Medicare Advantage	$118.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.69
Rate for Payer: Cigna Commercial	$197.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.33
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.23
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH-1STMED INITAL AVS

Facility

$394.88

Service Code	HCPCS 9637459
Hospital Charge Code	93500067
Hospital Revenue Code	260
Min. Negotiated Rate	$59.23
Max. Negotiated Rate	$59.23
Rate for Payer: Qualcare PPO/HMO/WC	$59.23

IV PUSH-1ST MED INITL 1VS

Facility

$394.88

Service Code	HCPCS 96374
Hospital Charge Code	93500063
Hospital Revenue Code	260
Min. Negotiated Rate	$36.51
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$118.46
Rate for Payer: Aetna Medicare Advantage	$118.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.69
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.33
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.23
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH-1ST MED INITL 1VS

Facility

$394.88

Service Code	HCPCS 96374
Hospital Charge Code	93500063
Hospital Revenue Code	260
Min. Negotiated Rate	$59.23
Max. Negotiated Rate	$59.23
Rate for Payer: Qualcare PPO/HMO/WC	$59.23

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	5100780
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	1600520
Hospital Revenue Code	260
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$132.27
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.32
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	93082020
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$2,800.00

Service Code	HCPCS 96375
Hospital Charge Code	5700257
Hospital Revenue Code	260
Min. Negotiated Rate	$111.50
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	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$111.50
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

IV PUSH EA ADDL DRUG NEW

Facility

$634.81

Service Code	HCPCS 96375
Hospital Charge Code	5700442
Hospital Revenue Code	450
Min. Negotiated Rate	$82.53
Max. Negotiated Rate	$190.44
Rate for Payer: Aetna Commercial	$190.44
Rate for Payer: Aetna Medicare Advantage	$190.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.88
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.53
Rate for Payer: Qualcare PPO/HMO/WC	$95.22

IV PUSH EA ADDL DRUG NEW

Facility

$2,800.00

Service Code	HCPCS 96375
Hospital Charge Code	321793675
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	2250412
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	2300906
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73092065
Hospital Revenue Code	260
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$132.27
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.32
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	2250412
Hospital Revenue Code	260
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$802.00
Rate for Payer: Aetna Commercial	$132.27
Rate for Payer: Aetna Medicare Advantage	$132.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.32
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.14
Rate for Payer: UnitedHealthcare Commercial	$802.00

IV PUSH EA ADDL DRUG NEW

Facility

$2,800.00

Service Code	HCPCS 96375
Hospital Charge Code	321793675
Hospital Revenue Code	260
Min. Negotiated Rate	$111.50
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	$146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$111.50
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

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	395096375
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	270339102
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	73092065
Hospital Revenue Code	260
Min. Negotiated Rate	$66.14
Max. Negotiated Rate	$66.14
Rate for Payer: Qualcare PPO/HMO/WC	$66.14

Know your out-of-pocket cost for care.

All Charges