Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW PEAKFLOW

Facility

$241.00

Service Code	HCPCS 94150
Hospital Charge Code	84206290
Hospital Revenue Code	460
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare Advantage	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.45
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.33
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.15
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

RW PEAKFLOW

Facility

$241.00

Service Code	HCPCS 94150
Hospital Charge Code	87502285
Hospital Revenue Code	460
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$36.15
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

RW PEAKFLOW

Facility

$241.00

Service Code	HCPCS 94150
Hospital Charge Code	87502285
Hospital Revenue Code	460
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare Advantage	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.45
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.33
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.15
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

RW PEDIAREX VACCINE VIAL

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	84206380
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$115.67
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

RW PEDIAREX VACCINE VIAL

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	84206380
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$39.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

RW PHARMACOLOGIC MANAGEMENT

Facility

$446.00

Service Code	HCPCS 90862
Hospital Charge Code	83652361
Hospital Revenue Code	914
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

RW PHARMACOLOGIC MANAGEMENT

Facility

$446.00

Service Code	HCPCS 90862
Hospital Charge Code	83652361
Hospital Revenue Code	914
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

RW PNEUMONOCCOCAL VAC

Facility

$1,400.88

Service Code	HCPCS 90732
Hospital Charge Code	87502925
Hospital Revenue Code	636
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$420.26
Rate for Payer: Cigna Commercial	$133.47
Rate for Payer: Aetna Commercial	$420.26
Rate for Payer: Aetna Medicare Advantage	$420.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.13

RW PNEUMONOCCOCAL VAC

Facility

$1,400.88

Service Code	HCPCS 90732
Hospital Charge Code	87502925
Hospital Revenue Code	636
Min. Negotiated Rate	$210.13
Max. Negotiated Rate	$339.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.13

RW PNEUMOVAX VIAL 0.5ML

Facility

$1,400.88

Service Code	HCPCS 90732
Hospital Charge Code	84206210
Hospital Revenue Code	636
Min. Negotiated Rate	$210.13
Max. Negotiated Rate	$339.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.13

RW PNEUMOVAX VIAL 0.5ML

Facility

$1,400.88

Service Code	HCPCS 90732
Hospital Charge Code	84206210
Hospital Revenue Code	636
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$420.26
Rate for Payer: Aetna Commercial	$420.26
Rate for Payer: Aetna Medicare Advantage	$420.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.22
Rate for Payer: Cigna Commercial	$133.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.01
Rate for Payer: Qualcare PPO/HMO/WC	$210.13

RW POL VACCINE IPV VIAL

Facility

$70.00

Service Code	HCPCS 90713
Hospital Charge Code	84206365
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 POL VACCINE IPV VIAL

Facility

$70.00

Service Code	HCPCS 90713
Hospital Charge Code	84206365
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$37.00
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	$37.00
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 PPD

Facility

$33.00

Service Code	HCPCS 86580
Hospital Charge Code	84206160
Hospital Revenue Code	302
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

RW PPD

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	87502305
Hospital Revenue Code	302
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$6.38
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

RW PPD

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	87502305
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW PPD

Facility

$33.00

Service Code	HCPCS 86580
Hospital Charge Code	84206160
Hospital Revenue Code	302
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$6.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

RW PREVNAR 0.5ML VIAL

Facility

$244.00

Hospital Charge Code	84206385
Hospital Revenue Code	636
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$59.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.05
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

RW PREVNAR 0.5ML VIAL

Facility

$244.00

Hospital Charge Code	84206385
Hospital Revenue Code	636
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$122.00
Rate for Payer: Aetna Commercial	$73.20
Rate for Payer: Aetna Medicare Advantage	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.05
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

RW PSYCH EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87502045
Hospital Revenue Code	900
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$1,994.00
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) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

RW PSYCH EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87502045
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW PSYCH EVALUATION

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84206225
Hospital Revenue Code	900
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$1,994.00
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: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

RW PSYCH EVALUATION

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84206225
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW PSYCHIATRIC DIAG EVAL W/MD

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	87502895
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

RW PSYCHIATRIC DIAG EVAL W/MD

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	87502895
Hospital Revenue Code	900
Min. Negotiated Rate	$422.69
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76

Know your out-of-pocket cost for care.

All Charges