Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW IND PSYTHER INTACT 20-30MIN

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	87502025
Hospital Revenue Code	914
Min. Negotiated Rate	$51.87
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Aetna Medicare Advantage	$119.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.75
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.87
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

RW IND PSYTHER INTACT 20-30MIN

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	87502025
Hospital Revenue Code	914
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$59.85
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

RW IND PSY THER INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	87502030
Hospital Revenue Code	914
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$160.80
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.68
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW IND PSY THER INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	87502030
Hospital Revenue Code	914
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW INDV PSYCHTHERPY 20-30 MTS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	84206230
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW INDV PSYCHTHERPY 20-30 MTS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	84206230
Hospital Revenue Code	914
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW INDV PSYCHTHRPY 45-50 MTS

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	84206235
Hospital Revenue Code	914
Min. Negotiated Rate	$185.09
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna Commercial	$427.14
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$711.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

RW INDV PSYCHTHRPY 45-50 MTS

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	84206235
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

RW INDV PSYCHTRPY INTACT 20-30

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	84206240
Hospital Revenue Code	914
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$59.85
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

RW INDV PSYCHTRPY INTACT 20-30

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	84206240
Hospital Revenue Code	914
Min. Negotiated Rate	$51.87
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Aetna Medicare Advantage	$119.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.75
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.87
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

RW INDV PSYTHRPY INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	84206245
Hospital Revenue Code	914
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW INDV PSYTHRPY INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	84206245
Hospital Revenue Code	914
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$160.80
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.68
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW INFANRIX VACCINE DTAP VIAL

Facility

$70.00

Service Code	HCPCS 90700
Hospital Charge Code	84206195
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

RW INFANRIX VACCINE DTAP VIAL

Facility

$70.00

Service Code	HCPCS 90700
Hospital Charge Code	84206195
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$21.00
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

RW INFLUENZA VIRUS VACCINE IM

Facility

$88.00

Service Code	HCPCS 90656
Hospital Charge Code	84206190
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$21.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RW INFLUENZA VIRUS VACCINE IM

Facility

$88.00

Service Code	HCPCS 90656
Hospital Charge Code	84206190
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$26.40
Rate for Payer: Aetna Commercial	$26.40
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RW INJ;SNGL TENDON;LIGMT;APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	84206075
Hospital Revenue Code	761
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$47.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.55

RW INJ;SNGL TENDON;LIGMT;APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	84206075
Hospital Revenue Code	761
Min. Negotiated Rate	$36.70
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$95.10
Rate for Payer: Aetna Medicare Advantage	$95.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.83
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.21
Rate for Payer: Oxford Commercial	$158.50
Rate for Payer: Qualcare PPO/HMO/WC	$47.55
Rate for Payer: UnitedHealthcare Commercial	$158.50

RW INJ, SNGL TEN/LIG APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	87502160
Hospital Revenue Code	761
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$47.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.55

RW INJ, SNGL TEN/LIG APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	87502160
Hospital Revenue Code	761
Min. Negotiated Rate	$36.70
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$95.10
Rate for Payer: Aetna Medicare Advantage	$95.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.83
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.21
Rate for Payer: Oxford Commercial	$158.50
Rate for Payer: Qualcare PPO/HMO/WC	$47.55
Rate for Payer: UnitedHealthcare Commercial	$158.50

RW IPRATROPIUM BROMIDE 0.02%

Facility

$2.00

Hospital Charge Code	83652631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

RW IPRATROPIUM BROMIDE 0.02%

Facility

$2.00

Hospital Charge Code	83652631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

RW I&REM FB SUBC TISS, COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10121
Hospital Charge Code	84206010
Hospital Revenue Code	761
Min. Negotiated Rate	$175.79
Max. Negotiated Rate	$4,474.27
Rate for Payer: Aetna Better Health Medicaid	$4,386.54
Rate for Payer: Aetna Commercial	$447.00
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.70
Rate for Payer: Oxford Commercial	$745.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Commercial	$745.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27

RW I&REM FB SUBC TISS, COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10121
Hospital Charge Code	84206010
Hospital Revenue Code	761
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

RW I&REM FB SUBC TISS SIMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	83652005
Hospital Revenue Code	761
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

Know your out-of-pocket cost for care.

All Charges