Heights University Hospital

All Charges

Charge

Type

Setting

Price

CBC PATHOLOGIST REVIEW

Facility

$133.65

Service Code	HCPCS 85060
Hospital Charge Code	3007978
Hospital Revenue Code	305
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

CBC W/AUTO DIFFERNTIAL

Facility

$449.40

Service Code	HCPCS 85025
Hospital Charge Code	38473003
Hospital Revenue Code	305
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$67.41

CBC W/AUTO DIFFERNTIAL

Facility

$449.40

Service Code	HCPCS 85025
Hospital Charge Code	38473003
Hospital Revenue Code	305
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.41
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.24
Rate for Payer: Wellcare Medicare Advantage	$7.77

CBC W/O DIFFERENTIAL

Facility

$183.00

Service Code	HCPCS 85027
Hospital Charge Code	38474116
Hospital Revenue Code	305
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
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	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

CBC W/O DIFFERENTIAL

Facility

$183.00

Service Code	HCPCS 85027
Hospital Charge Code	38474116
Hospital Revenue Code	305
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CCIIV4 VAC NO PRSV 0.5 ML IM

Facility

$72.45

Service Code	HCPCS 90674
Hospital Charge Code	412390674
Hospital Revenue Code	636
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$36.23
Rate for Payer: Aetna Commercial	$21.73
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$36.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.87

CCIIV4 VAC NO PRSV 0.5 ML IM

Facility

$72.45

Service Code	HCPCS 90674
Hospital Charge Code	412390674
Hospital Revenue Code	636
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$17.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.87

CCP IGG

Facility

$390.00

Service Code	HCPCS 86200
Hospital Charge Code	39900361
Hospital Revenue Code	302
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.96
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.45
Rate for Payer: Cigna Commercial	$12.95
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
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	$12.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.73
Rate for Payer: Wellcare Medicare Advantage	$12.95

CCP IGG

Facility

$390.00

Service Code	HCPCS 86200
Hospital Charge Code	39900361
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C,D 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656977
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656977
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 12MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656978
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 12MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656978
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C, D 12MM 5, 6 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656974
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C, D 12MM 5, 6 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656974
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 14MM PLATE 1,2 LPS-FLEX

Facility

$5,862.10

Hospital Charge Code	270656980
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 14MM PLATE 1,2 LPS-FLEX

Facility

$5,862.10

Hospital Charge Code	270656980
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 17MM 1.2 ART SURFACE

Facility

$5,862.10

Hospital Charge Code	270656982
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 17MM 1.2 ART SURFACE

Facility

$5,862.10

Hospital Charge Code	270656982
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$1,758.63
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

CD55 - CD59

Facility

$115.00

Service Code	HCPCS 88184
Hospital Charge Code	3035095C
Hospital Revenue Code	311
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095A
Hospital Revenue Code	300
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.45
Rate for Payer: Aetna Medicare Advantage	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.73
Rate for Payer: Cigna Commercial	$19.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$114.00

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095F
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095B
Hospital Revenue Code	300
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.45
Rate for Payer: Aetna Medicare Advantage	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.73
Rate for Payer: Cigna Commercial	$19.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$114.00

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095E
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095E
Hospital Revenue Code	311
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges