Heights University Hospital

All Charges

Charge

Type

Setting

Price

PREVACID IV 30MG

Facility

$9.00

Hospital Charge Code	60635481
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PREVALON TAP 2.0 TURN & POSITI

Facility

$623.80

Hospital Charge Code	270675835
Hospital Revenue Code	272
Min. Negotiated Rate	$93.57
Max. Negotiated Rate	$93.57
Rate for Payer: Qualcare PPO/HMO/WC	$93.57

PREVALON TAP 2.0 TURN & POSITI

Facility

$623.80

Hospital Charge Code	270675835
Hospital Revenue Code	272
Min. Negotiated Rate	$81.09
Max. Negotiated Rate	$311.90
Rate for Payer: Aetna Commercial	$187.14
Rate for Payer: Aetna Medicare Advantage	$187.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.07
Rate for Payer: Cigna Commercial	$311.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.09
Rate for Payer: Oxford Commercial	$311.90
Rate for Payer: Qualcare PPO/HMO/WC	$93.57
Rate for Payer: UnitedHealthcare Commercial	$311.90

PREV CONTRACEPTIVE KIT

Facility

$14.20

Service Code	NDC 68462063729
Hospital Charge Code	60635461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$2.13

PREV CONTRACEPTIVE KIT

Facility

$14.20

Service Code	NDC 68462063729
Hospital Charge Code	60635461
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$7.10
Rate for Payer: Aetna Commercial	$4.26
Rate for Payer: Aetna Medicare Advantage	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.62
Rate for Payer: Cigna Commercial	$7.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Oxford Commercial	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.13
Rate for Payer: UnitedHealthcare Commercial	$7.10

PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	73050830
Hospital Revenue Code	515
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	73050830
Hospital Revenue Code	515
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PREVENTIVE COUNSELING INDIV

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	395099401
Hospital Revenue Code	940
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

PREVENTIVE COUNSELING INDIV

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	395099401
Hospital Revenue Code	940
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

PREVENT.MED.COUNSELING 30 MTS

Facility

$62.00

Service Code	HCPCS 99402
Hospital Charge Code	83652499
Hospital Revenue Code	510
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$18.60
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

PREVENT.MED.COUNSELING 30 MTS

Facility

$62.00

Service Code	HCPCS 99402
Hospital Charge Code	83652499
Hospital Revenue Code	510
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

PREVENT.MED.COUNSELING 45 MTS

Facility

$131.00

Service Code	HCPCS 99403
Hospital Charge Code	83652501
Hospital Revenue Code	510
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

PREVENT.MED.COUNSELING 45 MTS

Facility

$131.00

Service Code	HCPCS 99403
Hospital Charge Code	83652501
Hospital Revenue Code	510
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

PREVENT.MED.COUNSELING-60MTS

Facility

$112.00

Service Code	HCPCS 99404
Hospital Charge Code	83652503
Hospital Revenue Code	510
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

PREVENT.MED.COUNSELING-60MTS

Facility

$112.00

Service Code	HCPCS 99404
Hospital Charge Code	83652503
Hospital Revenue Code	510
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$33.60
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

PREVNAR 0.5ML VIAL

Facility

$8,181.64

Service Code	HCPCS 90670
Hospital Charge Code	83652585
Hospital Revenue Code	636
Min. Negotiated Rate	$1,227.25
Max. Negotiated Rate	$4,090.82
Rate for Payer: Aetna Commercial	$2,454.49
Rate for Payer: Aetna Medicare Advantage	$2,454.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,086.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,086.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,086.32
Rate for Payer: Cigna Commercial	$4,090.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.25

PREVNAR 0.5ML VIAL

Facility

$8,181.64

Service Code	HCPCS 90670
Hospital Charge Code	83652585
Hospital Revenue Code	636
Min. Negotiated Rate	$1,227.25
Max. Negotiated Rate	$1,979.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.25

PREVNAR 13 EX

Facility

$1,221.14

Service Code	NDC 5197102
Hospital Charge Code	60630182EX
Hospital Revenue Code	259
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$183.17
Rate for Payer: Qualcare PPO/HMO/WC	$183.17

PREVNAR 13 EX

Facility

$1,221.14

Service Code	NDC 5197102
Hospital Charge Code	60630182EX
Hospital Revenue Code	259
Min. Negotiated Rate	$158.75
Max. Negotiated Rate	$610.57
Rate for Payer: Aetna Commercial	$366.34
Rate for Payer: Aetna Medicare Advantage	$366.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.39
Rate for Payer: Cigna Commercial	$610.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.75
Rate for Payer: Oxford Commercial	$610.57
Rate for Payer: Qualcare PPO/HMO/WC	$183.17
Rate for Payer: UnitedHealthcare Commercial	$610.57

PREVNAR13(PNEUMOCOCCA VAC) 0.5

Facility

$1,221.14

Service Code	HCPCS 90670
Hospital Charge Code	60630182
Hospital Revenue Code	636
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$295.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.52
Rate for Payer: Qualcare PPO/HMO/WC	$183.17

PREVNAR13(PNEUMOCOCCA VAC) 0.5

Facility

$1,221.14

Service Code	HCPCS 90670
Hospital Charge Code	60630182
Hospital Revenue Code	636
Min. Negotiated Rate	$183.17
Max. Negotiated Rate	$610.57
Rate for Payer: Aetna Commercial	$366.34
Rate for Payer: Aetna Medicare Advantage	$366.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.39
Rate for Payer: Cigna Commercial	$610.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.52
Rate for Payer: Qualcare PPO/HMO/WC	$183.17

PREZISTA 800MG TAB

Facility

$176.60

Hospital Charge Code	606351013
Hospital Revenue Code	250
Min. Negotiated Rate	$26.49
Max. Negotiated Rate	$26.49
Rate for Payer: Qualcare PPO/HMO/WC	$26.49

PREZISTA 800MG TAB

Facility

$176.60

Hospital Charge Code	606351013
Hospital Revenue Code	250
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$88.30
Rate for Payer: Aetna Commercial	$52.98
Rate for Payer: Aetna Medicare Advantage	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.03
Rate for Payer: Cigna Commercial	$88.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.96
Rate for Payer: Oxford Commercial	$88.30
Rate for Payer: Qualcare PPO/HMO/WC	$26.49
Rate for Payer: UnitedHealthcare Commercial	$88.30

PRG FETL ANAT ABD US EA ADDTL

Facility

$2,042.00

Service Code	HCPCS 76812
Hospital Charge Code	83653055
Hospital Revenue Code	402
Min. Negotiated Rate	$306.30
Max. Negotiated Rate	$306.30
Rate for Payer: Qualcare PPO/HMO/WC	$306.30

PRG FETL ANAT ABD US EA ADDTL

Facility

$2,042.00

Service Code	HCPCS 76812
Hospital Charge Code	83653055
Hospital Revenue Code	402
Min. Negotiated Rate	$219.55
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$612.60
Rate for Payer: Aetna Medicare Advantage	$612.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.71
Rate for Payer: Cigna Commercial	$219.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.30
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

Know your out-of-pocket cost for care.

All Charges