Heights University Hospital

All Charges

Charge

Type

Setting

Price

THERAPEUTIC APHERESIS

Facility

$2,700.00

Service Code	HCPCS 36513
Hospital Charge Code	3300020
Hospital Revenue Code	361
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

THERAPEUTIC APHERESIS

Facility

$2,700.00

Service Code	HCPCS 36513
Hospital Charge Code	3300020
Hospital Revenue Code	361
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

THERAPEUTIC BOTOX

Facility

$2,705.00

Hospital Charge Code	270666212
Hospital Revenue Code	636
Min. Negotiated Rate	$405.75
Max. Negotiated Rate	$1,352.50
Rate for Payer: Aetna Commercial	$811.50
Rate for Payer: Aetna Medicare Advantage	$811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.77
Rate for Payer: Cigna Commercial	$1,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.61
Rate for Payer: Qualcare PPO/HMO/WC	$405.75

THERAPEUTIC BOTOX

Facility

$2,705.00

Hospital Charge Code	270666212
Hospital Revenue Code	636
Min. Negotiated Rate	$405.75
Max. Negotiated Rate	$654.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.61
Rate for Payer: Qualcare PPO/HMO/WC	$405.75

THERAPEUTIC EX EA 15 MIN CQ

Facility

$223.95

Service Code	HCPCS 97110GP
Hospital Charge Code	409197110Q
Hospital Revenue Code	420
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$67.19
Rate for Payer: Aetna Medicare Advantage	$67.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.11
Rate for Payer: Cigna Commercial	$111.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.59
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAPEUTIC EX EA 15 MIN CQ

Facility

$223.95

Service Code	HCPCS 97110GP
Hospital Charge Code	409197110Q
Hospital Revenue Code	420
Min. Negotiated Rate	$33.59
Max. Negotiated Rate	$33.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.59

THERAPEUTIC FORK

Facility

$39.25

Hospital Charge Code	270613437
Hospital Revenue Code	279
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$19.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$19.62

THERAPEUTIC FORK

Facility

$39.25

Hospital Charge Code	270613437
Hospital Revenue Code	279
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.98
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$686.00

THERAPEUTIC INJECTION****

Facility

$2.75

Service Code	HCPCS 90782WF
Hospital Charge Code	9600026
Hospital Revenue Code	519
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna Commercial	$0.83
Rate for Payer: Aetna Medicare Advantage	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.70
Rate for Payer: Cigna Commercial	$1.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.36
Rate for Payer: Qualcare PPO/HMO/WC	$0.41

THERAPEUTIC INJECTION****

Facility

$2.75

Service Code	HCPCS 90782WF
Hospital Charge Code	9600026
Hospital Revenue Code	519
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.41

THERAPEUTIC KNIFE WITH HANDLE

Facility

$47.25

Hospital Charge Code	270613434
Hospital Revenue Code	279
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

THERAPEUTIC KNIFE WITH HANDLE

Facility

$47.25

Hospital Charge Code	270613434
Hospital Revenue Code	279
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.14
Rate for Payer: Oxford Commercial	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$23.62

THERAPEUTIC MULTI-VITAMIN

Facility

$1.00

Hospital Charge Code	60634013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

THERAPEUTIC MULTI-VITAMIN

Facility

$1.00

Hospital Charge Code	60634013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THERAPEUTIC MULTIVITAMIN

Facility

$3.00

Hospital Charge Code	60634014
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

THERAPEUTIC MULTIVITAMIN

Facility

$3.00

Hospital Charge Code	60634014
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$39.72
Rate for Payer: Qualcare PPO/HMO/WC	$39.72

THERAPEUTIC PHLEBOTOMY

Facility

$394.45

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$118.33
Rate for Payer: Aetna Medicare Advantage	$118.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.58
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.28
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.17
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$34.42
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$79.44
Rate for Payer: Aetna Medicare Advantage	$79.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.52
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.42
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.72
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

THERAPEUTIC PHLEBOTOMY

Facility

$394.45

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$59.17
Rate for Payer: Qualcare PPO/HMO/WC	$59.17

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$1,272.71
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,937.01
Rate for Payer: Aetna Medicare Advantage	$2,937.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,496.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,496.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,496.46
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

THERAPEUTIC PLASMA APHERESIS

Facility

$5,065.00

Service Code	HCPCS 36514
Hospital Charge Code	3300021
Hospital Revenue Code	361
Min. Negotiated Rate	$759.75
Max. Negotiated Rate	$759.75
Rate for Payer: Qualcare PPO/HMO/WC	$759.75

Know your out-of-pocket cost for care.

All Charges