Heights University Hospital

All Charges

Charge

Type

Setting

Price

PFIZER COV19 PEDS ADMIN DOSE 1

Facility

$50.00

Service Code	HCPCS 0071A
Hospital Charge Code	39500071A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZER COV19 PEDS ADMIN DOSE 2

Facility

$50.00

Service Code	HCPCS 0072A
Hospital Charge Code	39500072A
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

PFIZER COV19 PEDS ADMIN DOSE 2

Facility

$50.00

Service Code	HCPCS 0072A
Hospital Charge Code	39500072A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZER COV19 PEDS ADMIN DOSE 3

Facility

$50.00

Service Code	HCPCS 0073A
Hospital Charge Code	39500073A
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

PFIZER COV19 PEDS ADMIN DOSE 3

Facility

$50.00

Service Code	HCPCS 0073A
Hospital Charge Code	39500073A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZERPEN/1MU

Facility

$12.00

Hospital Charge Code	60633645
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

PFIZERPEN/1MU

Facility

$12.00

Hospital Charge Code	60633645
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

PFIZERPEN/20MU

Facility

$61.00

Hospital Charge Code	60633647
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

PFIZERPEN/20MU

Facility

$61.00

Hospital Charge Code	60633647
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

PFIZERPEN/5MU

Facility

$21.00

Hospital Charge Code	60633646
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

PFIZERPEN/5MU

Facility

$21.00

Hospital Charge Code	60633646
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

PF REMOV SKIN TAG & ADDTN'L 10

Facility

$59.77

Service Code	HCPCS 11201
Hospital Charge Code	83652033
Hospital Revenue Code	761
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.97

PF REMOV SKIN TAG & ADDTN'L 10

Facility

$59.77

Service Code	HCPCS 11201
Hospital Charge Code	83652033
Hospital Revenue Code	761
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$29.89
Rate for Payer: Aetna Commercial	$17.93
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.24
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.77
Rate for Payer: Oxford Commercial	$29.89
Rate for Payer: Qualcare PPO/HMO/WC	$8.97
Rate for Payer: UnitedHealthcare Commercial	$29.89

PGR PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061080
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$324.69
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$114.00

PGR PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061080
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

PHACO TIP 45 DEG.DISPOS.

Facility

$212.00

Hospital Charge Code	270332539
Hospital Revenue Code	272
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$63.60
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$106.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$106.00

PHACO TIP 45 DEG.DISPOS.

Facility

$212.00

Hospital Charge Code	270332539
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

PHARMACOKINETIC CONSULTATION

Facility

$215.05

Hospital Charge Code	6010102
Hospital Revenue Code	949
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$64.52
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.96
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

PHARMACOKINETIC CONSULTATION

Facility

$215.05

Hospital Charge Code	6010102
Hospital Revenue Code	949
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

PHARMACOKINETIC FOLLOW-UP

Facility

$90.90

Hospital Charge Code	6010110
Hospital Revenue Code	949
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

PHARMACOKINETIC FOLLOW-UP

Facility

$90.90

Hospital Charge Code	6010110
Hospital Revenue Code	949
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.82
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

PHARMACOLOGICAL MANAGEMENT

Facility

$428.58

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$55.72
Max. Negotiated Rate	$214.29
Rate for Payer: Aetna Commercial	$128.57
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PHARMACOLOGICAL MANAGEMENT

Facility

$428.58

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

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