Heights University Hospital

All Charges

Charge

Type

Setting

Price

VEDOLIZUMAB 300MG INJ

Facility

$38,744.76

Service Code	HCPCS J3380
Hospital Charge Code	606380023
Hospital Revenue Code	636
Min. Negotiated Rate	$5,811.71
Max. Negotiated Rate	$9,376.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,376.23
Rate for Payer: Qualcare PPO/HMO/WC	$5,811.71

VEDOLIZUMAB 300MG INJ

Facility

$38,744.76

Service Code	HCPCS J3380
Hospital Charge Code	606380023
Hospital Revenue Code	636
Min. Negotiated Rate	$5,811.71
Max. Negotiated Rate	$11,623.43
Rate for Payer: Aetna Commercial	$11,623.43
Rate for Payer: Aetna Medicare Advantage	$11,623.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,879.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,879.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,879.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,376.23
Rate for Payer: Qualcare PPO/HMO/WC	$5,811.71

VEEG 12-26HRS CONT MON

Facility

$5,322.08

Service Code	HCPCS 95716
Hospital Charge Code	405295716
Hospital Revenue Code	740
Min. Negotiated Rate	$691.87
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$1,596.62
Rate for Payer: Aetna Medicare Advantage	$1,596.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,357.13
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.87
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$798.31
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS CONT MON

Facility

$5,322.08

Service Code	HCPCS 95716
Hospital Charge Code	403395716
Hospital Revenue Code	740
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$798.31
Rate for Payer: Qualcare PPO/HMO/WC	$798.31

VEEG 12-26HRS CONT MON

Facility

$5,322.08

Service Code	HCPCS 95716
Hospital Charge Code	405295716
Hospital Revenue Code	740
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$798.31
Rate for Payer: Qualcare PPO/HMO/WC	$798.31

VEEG 12-26HRS CONT MON

Facility

$5,322.08

Service Code	HCPCS 95716
Hospital Charge Code	403395716
Hospital Revenue Code	740
Min. Negotiated Rate	$691.87
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$1,596.62
Rate for Payer: Aetna Medicare Advantage	$1,596.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,357.13
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.87
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$798.31
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95715
Hospital Charge Code	403395715
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95715
Hospital Charge Code	405295715
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95715
Hospital Charge Code	403395715
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95715
Hospital Charge Code	405295715
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95714
Hospital Charge Code	405295714
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95714
Hospital Charge Code	403395714
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95714
Hospital Charge Code	403395714
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95714
Hospital Charge Code	405295714
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 2-12HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95713
Hospital Charge Code	403395713
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 2-12HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95713
Hospital Charge Code	405295713
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

VEEG 2-12HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95713
Hospital Charge Code	405295713
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95713
Hospital Charge Code	403395713
Hospital Revenue Code	740
Min. Negotiated Rate	$369.63
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$853.00
Rate for Payer: Aetna Medicare Advantage	$853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.05
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.63
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95712
Hospital Charge Code	405295712
Hospital Revenue Code	740
Min. Negotiated Rate	$192.65
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$444.58
Rate for Payer: Aetna Medicare Advantage	$444.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.90
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.65
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95712
Hospital Charge Code	405295712
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

VEEG 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95712
Hospital Charge Code	403395712
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

VEEG 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95712
Hospital Charge Code	403395712
Hospital Revenue Code	740
Min. Negotiated Rate	$192.65
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$444.58
Rate for Payer: Aetna Medicare Advantage	$444.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.90
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.65
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS UNMON

Facility

$1,481.95

Service Code	HCPCS 95711
Hospital Charge Code	405295711
Hospital Revenue Code	740
Min. Negotiated Rate	$192.65
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$444.58
Rate for Payer: Aetna Medicare Advantage	$444.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.90
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.65
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS UNMON

Facility

$1,481.95

Service Code	HCPCS 95711
Hospital Charge Code	403395711
Hospital Revenue Code	740
Min. Negotiated Rate	$192.65
Max. Negotiated Rate	$3,847.00
Rate for Payer: Aetna Commercial	$444.58
Rate for Payer: Aetna Medicare Advantage	$444.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.90
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.65
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$3,847.00

VEEG 2-12HRS UNMON

Facility

$1,481.95

Service Code	HCPCS 95711
Hospital Charge Code	405295711
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

Know your out-of-pocket cost for care.

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