Heights University Hospital

All Charges

Charge

Type

Setting

Price

MULTIPLE SCLEROSIS PROF 1

Facility

$402.00

Service Code	HCPCS 83916
Hospital Charge Code	3035107A
Hospital Revenue Code	301
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

MULTIPLE SCLEROSIS PROF 2

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	3035117A
Hospital Revenue Code	307
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

MULTIPLE SCLEROSIS PROF 2

Facility

$204.00

Service Code	HCPCS 82042
Hospital Charge Code	3035117B
Hospital Revenue Code	307
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.21
Rate for Payer: Aetna Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.51
Rate for Payer: Cigna Commercial	$7.78
Rate for Payer: Cigna Medicare Advantage	$3.89
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.25
Rate for Payer: Wellcare Medicare Advantage	$7.78

MULTIPLE SCLEROSIS PROF 2

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035117C
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

MULTIPLE SCLEROSIS PROF 2

Facility

$402.00

Service Code	HCPCS 83916
Hospital Charge Code	3035117F
Hospital Revenue Code	301
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

MULTIPLE SCLEROSIS PROF 2

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035117D
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

MULTIPLE SCLEROSIS PROF 2

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035117D
Hospital Revenue Code	301
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$54.30

MULTIPLE SCLEROSIS PROF 2

Facility

$402.00

Service Code	HCPCS 83916
Hospital Charge Code	3035117G
Hospital Revenue Code	301
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

MULTIPLE SCLEROSIS PROF 2

Facility

$402.00

Service Code	HCPCS 83916
Hospital Charge Code	3035117G
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

MULTIPLE SCLEROSIS PROF 2

Facility

$402.00

Service Code	HCPCS 83916
Hospital Charge Code	3035117F
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

MULTIPLE SCLEROSIS PROF 2

Facility

$626.00

Service Code	HCPCS 83873
Hospital Charge Code	3035117E
Hospital Revenue Code	301
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.73
Rate for Payer: Aetna Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.02
Rate for Payer: Cigna Commercial	$17.20
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.23
Rate for Payer: Wellcare Medicare Advantage	$17.20

MULTIPLE SCLEROSIS PROF 2

Facility

$626.00

Service Code	HCPCS 83873
Hospital Charge Code	3035117E
Hospital Revenue Code	301
Min. Negotiated Rate	$93.90
Max. Negotiated Rate	$93.90
Rate for Payer: Qualcare PPO/HMO/WC	$93.90

MULTIPLE SCLEROSIS PROF 2

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	3035117A
Hospital Revenue Code	307
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.14
Rate for Payer: Cigna Commercial	$4.95
Rate for Payer: Cigna Medicare Advantage	$2.48
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.25
Rate for Payer: Wellcare Medicare Advantage	$4.95

MULTIPLE SCLEROSIS PROF 2

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035117C
Hospital Revenue Code	301
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$54.30

MULTIPLE SCLEROSIS PROF 2

Facility

$204.00

Service Code	HCPCS 82042
Hospital Charge Code	3035117B
Hospital Revenue Code	307
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

MULTIPLE SCLEROSIS PROFILE, MS

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3006905
Hospital Revenue Code	301
Min. Negotiated Rate	$38.65
Max. Negotiated Rate	$38.65
Rate for Payer: Qualcare PPO/HMO/WC	$38.65

MULTIPLE SCLEROSIS PROFILE, MS

Facility

$257.65

Service Code	HCPCS 83873
Hospital Charge Code	3006905
Hospital Revenue Code	301
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.73
Rate for Payer: Aetna Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.02
Rate for Payer: Cigna Commercial	$17.20
Rate for Payer: Cigna Medicare Advantage	$8.60
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.23
Rate for Payer: Wellcare Medicare Advantage	$17.20

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$10,594.67

Service Code	APR-DRG 9301
Min. Negotiated Rate	$7,533.11
Max. Negotiated Rate	$10,594.67
Rate for Payer: Aetna Better Health Medicaid	$10,386.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,594.67
Rate for Payer: Wellpoint Medicaid Managed Care	$7,533.11

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$42,270.27

Service Code	APR-DRG 9304
Min. Negotiated Rate	$38,434.60
Max. Negotiated Rate	$42,270.27
Rate for Payer: Aetna Better Health Medicaid	$38,434.60
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,203.29
Rate for Payer: Wellpoint Medicaid Managed Care	$42,270.27

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$19,884.60

Service Code	APR-DRG 9303
Min. Negotiated Rate	$15,966.99
Max. Negotiated Rate	$19,884.60
Rate for Payer: Aetna Better Health Medicaid	$19,494.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,884.60
Rate for Payer: Wellpoint Medicaid Managed Care	$15,966.99

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$12,466.68

Service Code	APR-DRG 9302
Min. Negotiated Rate	$10,134.54
Max. Negotiated Rate	$12,466.68
Rate for Payer: Aetna Better Health Medicaid	$12,222.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,466.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10,134.54

MULTIPLE SLEEP LATENCY - MSLT

Facility

$1,915.25

Service Code	HCPCS 95805
Hospital Charge Code	9501280
Hospital Revenue Code	920
Min. Negotiated Rate	$248.98
Max. Negotiated Rate	$11,682.00
Rate for Payer: Aetna Commercial	$574.58
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.98
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$287.29
Rate for Payer: UnitedHealthcare Commercial	$11,682.00

MULTIPLE SLEEP LATENCY - MSLT

Facility

$1,915.25

Service Code	HCPCS 95805
Hospital Charge Code	9501280
Hospital Revenue Code	920
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$287.29
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

MULTIPLE VITAMINS INJ 10 ML

Facility

$59.09

Service Code	NDC 54643564901
Hospital Charge Code	6012876
Hospital Revenue Code	250
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$8.86
Rate for Payer: Qualcare PPO/HMO/WC	$8.86

MULTIPLE VITAMINS INJ 10 ML

Facility

$59.09

Service Code	NDC 54643564901
Hospital Charge Code	6012876
Hospital Revenue Code	250
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$29.55
Rate for Payer: Aetna Commercial	$17.73
Rate for Payer: Aetna Medicare Advantage	$17.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.07
Rate for Payer: Cigna Commercial	$29.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$29.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.86
Rate for Payer: UnitedHealthcare Commercial	$29.55

Know your out-of-pocket cost for care.

All Charges