Heights University Hospital

All Charges

Charge

Type

Setting

Price

CHEST W/O & HIGH RES CHEST

Facility

$9,500.00

Service Code	HCPCS 71250
Hospital Charge Code	2200104
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CHEST W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 71270
Hospital Charge Code	2200095
Hospital Revenue Code	352
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CHEST W/WO CONTRAST

Facility

$9,500.00

Service Code	HCPCS 71270
Hospital Charge Code	2200095
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CH ETHANOL, URINE

Facility

$180.00

Service Code	HCPCS 80300
Hospital Charge Code	397073221
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CH ETHANOL, URINE

Facility

$180.00

Service Code	HCPCS 80300
Hospital Charge Code	397073221
Hospital Revenue Code	301
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH ETHOSUXIMIDE

Facility

$216.00

Service Code	HCPCS 80168
Hospital Charge Code	397072065
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.94
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.87
Rate for Payer: Cigna Commercial	$16.34
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$15.52
Rate for Payer: EmblemHealth Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$16.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.32
Rate for Payer: Wellcare Medicare Advantage	$16.34

CH ETHOSUXIMIDE

Facility

$216.00

Service Code	HCPCS 80168
Hospital Charge Code	397072065
Hospital Revenue Code	301
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

CH ETHYLENE GLYCOL

Facility

$258.00

Service Code	HCPCS 82693
Hospital Charge Code	397072066
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.28
Rate for Payer: Aetna Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$14.90
Rate for Payer: Cigna Medicare Advantage	$7.45
Rate for Payer: Clover Medicare Advantage	$14.15
Rate for Payer: EmblemHealth Commercial	$44.70
Rate for Payer: Humana Medicare Advantage	$15.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.79
Rate for Payer: Wellcare Medicare Advantage	$14.90

CH ETHYLENE GLYCOL

Facility

$258.00

Service Code	HCPCS 82693
Hospital Charge Code	397072066
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073288
Hospital Revenue Code	301
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073295
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH EXTRACTION

Facility

$162.00

Service Code	HCPCS 83890
Hospital Charge Code	397073560
Hospital Revenue Code	301
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073288
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH EXTRACTION

Facility

$65.00

Service Code	HCPCS 83890
Hospital Charge Code	397073295
Hospital Revenue Code	301
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH EXTRACTION

Facility

$162.00

Service Code	HCPCS 83890
Hospital Charge Code	397073560
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH EXTRACTION X3

Facility

$40.00

Service Code	HCPCS 83890
Hospital Charge Code	397073280
Hospital Revenue Code	301
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH EXTRACTION X3

Facility

$40.00

Service Code	HCPCS 83890
Hospital Charge Code	397073280
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CH FACTOR 8 ACTIVITY

Facility

$218.00

Service Code	HCPCS 85240
Hospital Charge Code	397073316
Hospital Revenue Code	305
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.00
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.59
Rate for Payer: Cigna Commercial	$17.90
Rate for Payer: Cigna Medicare Advantage	$8.95
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.97
Rate for Payer: Wellcare Medicare Advantage	$17.90

CH FACTOR 8 ACTIVITY

Facility

$218.00

Service Code	HCPCS 85240
Hospital Charge Code	397073316
Hospital Revenue Code	305
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

CH FACTOR 8 INHIBITOR

Facility

$286.00

Service Code	HCPCS 85335
Hospital Charge Code	397072067
Hospital Revenue Code	305
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.16
Rate for Payer: Cigna Commercial	$12.87
Rate for Payer: Cigna Medicare Advantage	$6.43
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.64
Rate for Payer: Wellcare Medicare Advantage	$12.87

CH FACTOR 8 INHIBITOR

Facility

$286.00

Service Code	HCPCS 85335
Hospital Charge Code	397072067
Hospital Revenue Code	305
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

CH FACTOR 8 INJ EACH UNIT

Facility

$1.00

Service Code	HCPCS J7194
Hospital Charge Code	397031073
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CH FACTOR 8 INJ EACH UNIT

Facility

$1.00

Service Code	HCPCS J7194
Hospital Charge Code	397031073
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.30
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: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CH FACTOR 8 RELATED ANTIGEN

Facility

$332.00

Service Code	HCPCS 85244
Hospital Charge Code	397073168
Hospital Revenue Code	305
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$66.16
Rate for Payer: Aetna Medicare Advantage	$20.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.82
Rate for Payer: Cigna Commercial	$20.42
Rate for Payer: Cigna Medicare Advantage	$10.21
Rate for Payer: Clover Medicare Advantage	$19.40
Rate for Payer: EmblemHealth Commercial	$61.26
Rate for Payer: Humana Medicare Advantage	$21.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.42
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.65
Rate for Payer: Wellcare Medicare Advantage	$20.42

CH FACTOR 8 RELATED ANTIGEN

Facility

$332.00

Service Code	HCPCS 85244
Hospital Charge Code	397073168
Hospital Revenue Code	305
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

Know your out-of-pocket cost for care.

All Charges