Heights University Hospital

All Charges

Charge

Type

Setting

Price

SER.FLUID DIFFERENTIAL

Facility

$183.00

Service Code	HCPCS 89051
Hospital Charge Code	38479053
Hospital Revenue Code	309
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.14
Rate for Payer: Aetna Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.52
Rate for Payer: Cigna Commercial	$5.60
Rate for Payer: Cigna Medicare Advantage	$2.80
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.94
Rate for Payer: Wellcare Medicare Advantage	$5.60

SERIES A PAT WR 37 MM 1 PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690277
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SERIES A PAT WR 37 MM 1 PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690277
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SEROLOGY

Facility

$133.00

Service Code	HCPCS 86696
Hospital Charge Code	39900242
Hospital Revenue Code	302
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.69
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.90
Rate for Payer: Cigna Commercial	$19.35
Rate for Payer: Cigna Medicare Advantage	$9.68
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.51
Rate for Payer: Wellcare Medicare Advantage	$19.35

SEROLOGY

Facility

$133.00

Service Code	HCPCS 86696
Hospital Charge Code	39900242
Hospital Revenue Code	302
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$19.95
Rate for Payer: Qualcare PPO/HMO/WC	$19.95

SEROLOGY WB

Facility

$133.00

Service Code	HCPCS 86689
Hospital Charge Code	39900239
Hospital Revenue Code	302
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$19.95
Rate for Payer: Qualcare PPO/HMO/WC	$19.95

SEROLOGY WB

Facility

$133.00

Service Code	HCPCS 86689
Hospital Charge Code	39900239
Hospital Revenue Code	302
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.69
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.90
Rate for Payer: Cigna Commercial	$19.35
Rate for Payer: Cigna Medicare Advantage	$9.68
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.29
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.51
Rate for Payer: Wellcare Medicare Advantage	$19.35

SEROMYCIN/250MG/CAP

Facility

$40.20

Service Code	NDC 13845120202
Hospital Charge Code	60634940
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

SEROMYCIN/250MG/CAP

Facility

$40.20

Service Code	NDC 13845120202
Hospital Charge Code	60634940
Hospital Revenue Code	250
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$12.06
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$20.10

SEROQUEL 100MG TAB UD

Facility

$6.00

Hospital Charge Code	60635212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SEROQUEL 100MG TAB UD

Facility

$6.00

Hospital Charge Code	60635212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SEROQUEL 200MG TAB UD

Facility

$81.87

Service Code	NDC 68084053301
Hospital Charge Code	60635213
Hospital Revenue Code	250
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$40.94
Rate for Payer: Aetna Commercial	$24.56
Rate for Payer: Aetna Medicare Advantage	$24.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.88
Rate for Payer: Cigna Commercial	$40.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.64
Rate for Payer: Oxford Commercial	$40.94
Rate for Payer: Qualcare PPO/HMO/WC	$12.28
Rate for Payer: UnitedHealthcare Commercial	$40.94

SEROQUEL 200MG TAB UD

Facility

$81.87

Service Code	NDC 68084053301
Hospital Charge Code	60635213
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$12.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.28

SEROQUEL 25MG TAB UD

Facility

$4.00

Hospital Charge Code	60635211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SEROQUEL 25MG TAB UD

Facility

$4.00

Hospital Charge Code	60635211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SEROQUEL 50MG TAB

Facility

$44.02

Service Code	NDC 310027810
Hospital Charge Code	60635585
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.01
Rate for Payer: Aetna Commercial	$13.21
Rate for Payer: Aetna Medicare Advantage	$13.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.23
Rate for Payer: Cigna Commercial	$22.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.01

SEROQUEL 50MG TAB

Facility

$44.02

Service Code	NDC 310027810
Hospital Charge Code	60635585
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SEROQUEL XR 300MG TAB

Facility

$48.00

Hospital Charge Code	60635656
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

SEROQUEL XR 300MG TAB

Facility

$48.00

Hospital Charge Code	60635656
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SEROQUEL XR 50MG

Facility

$27.18

Hospital Charge Code	60635820
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$13.59
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$8.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.93
Rate for Payer: Cigna Commercial	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.53
Rate for Payer: Oxford Commercial	$13.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.08
Rate for Payer: UnitedHealthcare Commercial	$13.59

SEROQUEL XR 50MG

Facility

$27.18

Hospital Charge Code	60635820
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.08

SEROTONIN

Facility

$425.00

Service Code	HCPCS 84260
Hospital Charge Code	38472666
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.51
Rate for Payer: Cigna Commercial	$30.98
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.84
Rate for Payer: Wellcare Medicare Advantage	$30.98

SEROTONIN

Facility

$425.00

Service Code	HCPCS 84260
Hospital Charge Code	38472666
Hospital Revenue Code	301
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SEROTONIN,BLOOD

Facility

$390.00

Service Code	HCPCS 84260
Hospital Charge Code	39900131
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEROTONIN,BLOOD

Facility

$390.00

Service Code	HCPCS 84260
Hospital Charge Code	39900131
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.51
Rate for Payer: Cigna Commercial	$30.98
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
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	$30.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.84
Rate for Payer: Wellcare Medicare Advantage	$30.98

Know your out-of-pocket cost for care.

All Charges