Heights University Hospital

All Charges

Charge

Type

Setting

Price

RHINO ROCKET - MEDIUM****

Facility

$5.00

Hospital Charge Code	8003238
Hospital Revenue Code	279
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

RHO D 300MG VIAL/INJ

Facility

$593.30

Hospital Charge Code	6009701
Hospital Revenue Code	636
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$296.65
Rate for Payer: Aetna Commercial	$177.99
Rate for Payer: Aetna Medicare Advantage	$177.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.29
Rate for Payer: Cigna Commercial	$296.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.58
Rate for Payer: Qualcare PPO/HMO/WC	$89.00

RHO D 300MG VIAL/INJ

Facility

$593.30

Hospital Charge Code	6009701
Hospital Revenue Code	636
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$143.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.58
Rate for Payer: Qualcare PPO/HMO/WC	$89.00

RHO(D) IMM GLOBULIN 300MCG INJ

Facility

$2,700.17

Service Code	HCPCS J2792
Hospital Charge Code	60628296
Hospital Revenue Code	636
Min. Negotiated Rate	$405.03
Max. Negotiated Rate	$810.05
Rate for Payer: Aetna Commercial	$810.05
Rate for Payer: Aetna Medicare Advantage	$810.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.44
Rate for Payer: Qualcare PPO/HMO/WC	$405.03

RHO(D) IMM GLOBULIN 300MCG INJ

Facility

$2,700.17

Service Code	HCPCS J2792
Hospital Charge Code	60628296
Hospital Revenue Code	636
Min. Negotiated Rate	$405.03
Max. Negotiated Rate	$653.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.44
Rate for Payer: Qualcare PPO/HMO/WC	$405.03

RHO(D) IMMUNE GLOB INJ 5000U

Facility

$5,407.50

Hospital Charge Code	60629007
Hospital Revenue Code	636
Min. Negotiated Rate	$811.12
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Commercial	$1,622.25
Rate for Payer: Aetna Medicare Advantage	$1,622.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,378.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,378.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,378.91
Rate for Payer: Cigna Commercial	$2,703.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,308.62
Rate for Payer: Qualcare PPO/HMO/WC	$811.12

RHO(D) IMMUNE GLOB INJ 5000U

Facility

$5,407.50

Hospital Charge Code	60629007
Hospital Revenue Code	636
Min. Negotiated Rate	$811.12
Max. Negotiated Rate	$1,308.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,308.62
Rate for Payer: Qualcare PPO/HMO/WC	$811.12

RHO(D) IMMUNE GLOB INJ 60OU

Facility

$670.00

Hospital Charge Code	60628297
Hospital Revenue Code	636
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$201.00
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

RHO(D) IMMUNE GLOB INJ 60OU

Facility

$670.00

Hospital Charge Code	60628297
Hospital Revenue Code	636
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

RHO D IMMUNE GLOBULIN 100IU

Facility

$126.55

Service Code	HCPCS J2792
Hospital Charge Code	365212792
Hospital Revenue Code	636
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$30.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.63
Rate for Payer: Qualcare PPO/HMO/WC	$18.98

RHO D IMMUNE GLOBULIN 100IU

Facility

$126.55

Service Code	HCPCS J2792
Hospital Charge Code	365212792
Hospital Revenue Code	636
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$37.97
Rate for Payer: Aetna Commercial	$37.97
Rate for Payer: Aetna Medicare Advantage	$37.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.63
Rate for Payer: Qualcare PPO/HMO/WC	$18.98

RH-O(D) IMMUNOGLOBULIN

Facility

$883.85

Hospital Charge Code	6004790
Hospital Revenue Code	636
Min. Negotiated Rate	$132.58
Max. Negotiated Rate	$213.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.89
Rate for Payer: Qualcare PPO/HMO/WC	$132.58

RH-O(D) IMMUNOGLOBULIN

Facility

$883.85

Hospital Charge Code	6004790
Hospital Revenue Code	636
Min. Negotiated Rate	$132.58
Max. Negotiated Rate	$441.93
Rate for Payer: Aetna Commercial	$265.15
Rate for Payer: Aetna Medicare Advantage	$265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.38
Rate for Payer: Cigna Commercial	$441.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.89
Rate for Payer: Qualcare PPO/HMO/WC	$132.58

RHOGAM

Facility

$150.00

Service Code	HCPCS 90385
Hospital Charge Code	270325504
Hospital Revenue Code	636
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RHOGAM

Facility

$215.00

Service Code	HCPCS 90384
Hospital Charge Code	3100135
Hospital Revenue Code	250
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

RHOGAM

Facility

$215.00

Service Code	HCPCS 90384
Hospital Charge Code	3100135
Hospital Revenue Code	250
Min. Negotiated Rate	$27.95
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$64.50
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: Oxford Commercial	$107.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$107.50

RHOGAM

Facility

$150.00

Service Code	HCPCS 90385
Hospital Charge Code	270325504
Hospital Revenue Code	636
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RHOGAM (1 VIAL)

Facility

$499.00

Hospital Charge Code	38471010
Hospital Revenue Code	636
Min. Negotiated Rate	$74.85
Max. Negotiated Rate	$249.50
Rate for Payer: Aetna Commercial	$149.70
Rate for Payer: Aetna Medicare Advantage	$149.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.25
Rate for Payer: Cigna Commercial	$249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.76
Rate for Payer: Qualcare PPO/HMO/WC	$74.85

RHOGAM (1 VIAL)

Facility

$499.00

Hospital Charge Code	38471010
Hospital Revenue Code	636
Min. Negotiated Rate	$74.85
Max. Negotiated Rate	$120.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.76
Rate for Payer: Qualcare PPO/HMO/WC	$74.85

RHOGAM WORK UP PANEL

Facility

$363.25

Service Code	HCPCS 86870
Hospital Charge Code	3100138
Hospital Revenue Code	300
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$54.49
Rate for Payer: Qualcare PPO/HMO/WC	$54.49

RHOGAM WORK UP PANEL

Facility

$363.25

Service Code	HCPCS 86870
Hospital Charge Code	3100138
Hospital Revenue Code	300
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$108.97
Rate for Payer: Aetna Medicare Advantage	$108.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.63
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

RHOTON-TYPE BALL DISS 71/2 STR

Facility

$818.25

Hospital Charge Code	270691413
Hospital Revenue Code	272
Min. Negotiated Rate	$122.74
Max. Negotiated Rate	$122.74
Rate for Payer: Qualcare PPO/HMO/WC	$122.74

RHOTON-TYPE BALL DISS 71/2 STR

Facility

$818.25

Hospital Charge Code	270691413
Hospital Revenue Code	272
Min. Negotiated Rate	$106.37
Max. Negotiated Rate	$409.12
Rate for Payer: Aetna Commercial	$245.47
Rate for Payer: Aetna Medicare Advantage	$245.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.65
Rate for Payer: Cigna Commercial	$409.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.37
Rate for Payer: Oxford Commercial	$409.12
Rate for Payer: Qualcare PPO/HMO/WC	$122.74
Rate for Payer: UnitedHealthcare Commercial	$409.12

RH PHENO (RH PHENOTYPE PAT TES

Facility

$390.00

Service Code	HCPCS 86906
Hospital Charge Code	3100558
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RH PHENO (RH PHENOTYPE PAT TES

Facility

$390.00

Service Code	HCPCS 86906
Hospital Charge Code	3100558
Hospital Revenue Code	300
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.11
Rate for Payer: Aetna Medicare Advantage	$7.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.40
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.36
Rate for Payer: EmblemHealth Commercial	$23.25
Rate for Payer: Humana Medicare Advantage	$7.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.21
Rate for Payer: Wellcare Medicare Advantage	$7.75

Know your out-of-pocket cost for care.

All Charges