Heights University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN B3

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900518
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B5 (PANTOTHENC AC)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39708040
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B5 (PANTOTHENC AC)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39708040
Hospital Revenue Code	306
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.27
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.51
Rate for Payer: Cigna Commercial	$17.06
Rate for Payer: Cigna Medicare Advantage	$8.53
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
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	$17.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.08
Rate for Payer: Wellcare Medicare Advantage	$17.06

VITAMIN B6 (PIRIDOXAL PHOSPH)

Facility

$278.45

Service Code	HCPCS 84207
Hospital Charge Code	3007762
Hospital Revenue Code	301
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$41.77
Rate for Payer: Qualcare PPO/HMO/WC	$41.77

VITAMIN B6 (PIRIDOXAL PHOSPH)

Facility

$278.45

Service Code	HCPCS 84207
Hospital Charge Code	3007762
Hospital Revenue Code	301
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Better Health Medicaid	$23,605.88
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.96
Rate for Payer: Cigna Commercial	$28.10
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.79
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00

VITAMIN B6,PLASMA

Facility

$193.10

Service Code	HCPCS 84207
Hospital Charge Code	39900126
Hospital Revenue Code	301
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Better Health Medicaid	$23,605.88
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.96
Rate for Payer: Cigna Commercial	$28.10
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.96
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.79
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00

VITAMIN B6,PLASMA

Facility

$193.10

Service Code	HCPCS 84207
Hospital Charge Code	39900126
Hospital Revenue Code	301
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$28.96
Rate for Payer: Qualcare PPO/HMO/WC	$28.96

VITAMIN B6 (PYRIDOXAL PHOSPHAT

Facility

$514.00

Service Code	HCPCS 84207
Hospital Charge Code	38472689
Hospital Revenue Code	301
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Better Health Medicaid	$23,605.88
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.96
Rate for Payer: Cigna Commercial	$28.10
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.79
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00

VITAMIN B6 (PYRIDOXAL PHOSPHAT

Facility

$514.00

Service Code	HCPCS 84207
Hospital Charge Code	38472689
Hospital Revenue Code	301
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

VITAMIN B-6 PYRIDOXINE/50

Facility

$1.00

Hospital Charge Code	60634160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

VITAMIN B-6 PYRIDOXINE/50

Facility

$1.00

Hospital Charge Code	60634160
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

VITAMIN B7 (BIOTIN)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900150
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B7 (BIOTIN)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900150
Hospital Revenue Code	301
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.27
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.51
Rate for Payer: Cigna Commercial	$17.06
Rate for Payer: Cigna Medicare Advantage	$8.53
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
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	$17.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.08
Rate for Payer: Wellcare Medicare Advantage	$17.06

VITAMIN C, 24 HOUR URINE

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002774
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.48
Rate for Payer: Wellcare Medicare Advantage	$9.89

VITAMIN C, 24 HOUR URINE

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002774
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VITAMIN C (ASCORBIC ACID)

Facility

$231.00

Service Code	HCPCS 82180
Hospital Charge Code	38472695
Hospital Revenue Code	301
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$34.65
Rate for Payer: Qualcare PPO/HMO/WC	$34.65

VITAMIN C (ASCORBIC ACID)

Facility

$231.00

Service Code	HCPCS 82180
Hospital Charge Code	38472695
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.48
Rate for Payer: Wellcare Medicare Advantage	$9.89

VITAMIN C, ASORBIC ACID

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002771
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.48
Rate for Payer: Wellcare Medicare Advantage	$9.89

VITAMIN C, ASORBIC ACID

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002771
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VITAMIN C,SERUM

Facility

$390.00

Service Code	HCPCS 82180
Hospital Charge Code	39900046
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.04
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
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	$9.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.48
Rate for Payer: Wellcare Medicare Advantage	$9.89

VITAMIN C,SERUM

Facility

$390.00

Service Code	HCPCS 82180
Hospital Charge Code	39900046
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN D,1,25 DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	3000601
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$141.06
Rate for Payer: Aetna Commercial	$124.74
Rate for Payer: Aetna Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.06
Rate for Payer: Cigna Commercial	$38.50
Rate for Payer: Cigna Medicare Advantage	$19.25
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$40.81
Rate for Payer: Wellcare Medicare Advantage	$38.50

VITAMIN D,1,25 DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	3000601
Hospital Revenue Code	301
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

VITAMIN D,1,25 DIHYDROXY***

Facility

$436.00

Hospital Charge Code	3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$65.40
Max. Negotiated Rate	$65.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.40

VITAMIN D,1,25 DIHYDROXY***

Facility

$436.00

Hospital Charge Code	3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$56.68
Max. Negotiated Rate	$218.00
Rate for Payer: Aetna Commercial	$130.80
Rate for Payer: Aetna Medicare Advantage	$130.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.18
Rate for Payer: Cigna Commercial	$218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.40
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges