Heights University Hospital

All Charges

Charge

Type

Setting

Price

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	7411768
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,834.53

Service Code	APR-DRG 7931
Min. Negotiated Rate	$13,563.26
Max. Negotiated Rate	$13,834.53
Rate for Payer: Aetna Better Health Medicaid	$13,563.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,834.53

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$18,091.27

Service Code	APR-DRG 7932
Min. Negotiated Rate	$17,736.54
Max. Negotiated Rate	$18,091.27
Rate for Payer: Aetna Better Health Medicaid	$17,736.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,091.27

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$26,672.03

Service Code	APR-DRG 7933
Min. Negotiated Rate	$26,149.05
Max. Negotiated Rate	$26,672.03
Rate for Payer: Aetna Better Health Medicaid	$26,149.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,672.03

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$51,081.57

Service Code	APR-DRG 7934
Min. Negotiated Rate	$50,079.97
Max. Negotiated Rate	$51,081.57
Rate for Payer: Aetna Better Health Medicaid	$50,079.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,081.57

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$15,338.64

Service Code	APR-DRG 9511
Min. Negotiated Rate	$10,128.61
Max. Negotiated Rate	$15,338.64
Rate for Payer: Aetna Better Health Medicaid	$15,037.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,338.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10,128.61

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$20,303.11

Service Code	APR-DRG 9512
Min. Negotiated Rate	$14,467.66
Max. Negotiated Rate	$20,303.11
Rate for Payer: Aetna Better Health Medicaid	$19,905.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,303.11
Rate for Payer: Wellpoint Medicaid Managed Care	$14,467.66

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,323.41

Service Code	APR-DRG 9513
Min. Negotiated Rate	$23,762.06
Max. Negotiated Rate	$30,323.41
Rate for Payer: Aetna Better Health Medicaid	$29,728.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,323.41
Rate for Payer: Wellpoint Medicaid Managed Care	$23,762.06

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$54,405.72

Service Code	APR-DRG 9514
Min. Negotiated Rate	$45,419.14
Max. Negotiated Rate	$54,405.72
Rate for Payer: Aetna Better Health Medicaid	$53,338.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$54,405.72
Rate for Payer: Wellpoint Medicaid Managed Care	$45,419.14

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$318.00

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$190.80
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Oxford Commercial	$318.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$318.00

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNACOV19BIVALADLDOADM6TO11

Facility

$50.00

Service Code	HCPCS 0141A
Hospital Charge Code	39500144A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNACOV19BIVALADLDOADM6TO11

Facility

$50.00

Service Code	HCPCS 0141A
Hospital Charge Code	39500144A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNACOV19BIVALADLDOSEADMADT

Facility

$50.00

Service Code	HCPCS 0134A
Hospital Charge Code	39500134A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNACOV19BIVALADLDOSEADMADT

Facility

$50.00

Service Code	HCPCS 0134A
Hospital Charge Code	39500134A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNA COV19 VAC 100MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91301
Hospital Charge Code	606390387
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNA COV19 VAC 100MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91301
Hospital Charge Code	606390387
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNA COV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0094A
Hospital Charge Code	39500094A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MODERNA COV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0094A
Hospital Charge Code	39500094A
Hospital Revenue Code	771
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$103.00

MODERNACOV19 VAX ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0064A
Hospital Charge Code	39500064A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

Know your out-of-pocket cost for care.

All Charges