Heights University Hospital

All Charges

Charge

Type

Setting

Price

IV PUSH EA ADDL DRUG NEW

Facility

$440.91

Service Code	HCPCS 96375
Hospital Charge Code	8200513
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	73050955
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	93082040
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	93500069
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	411096375
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	7411253
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	2400613
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	2300906
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	93500075
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	411096375
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	73190111
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	4501033
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	93500075
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	2011450
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	2011450
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	7411253
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	100114
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	3400259
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	366896375
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	1500105
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	321096375
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

$2,800.00

Service Code	HCPCS 96375
Hospital Charge Code	321096375
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	93500069
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 SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	1600525
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 SAME

Facility

$440.91

Service Code	HCPCS 96376
Hospital Charge Code	2250413
Hospital Revenue Code	260
Min. Negotiated Rate	$9.25
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	$9.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.43
Rate for Payer: Cigna Commercial	$220.46
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

Know your out-of-pocket cost for care.

All Charges