Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH FLUAB

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	397040095
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CH FLUAB

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	397040095
Hospital Revenue Code	306
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.62
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: Cigna Medicare Advantage	$8.28
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.54
Rate for Payer: Wellcare Medicare Advantage	$16.55

CH FLUNITRAZEPAM/MET CONF(S)

Facility

$832.00

Service Code	HCPCS 80300
Hospital Charge Code	397071435
Hospital Revenue Code	301
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$416.00
Rate for Payer: Aetna Commercial	$249.60
Rate for Payer: Aetna Medicare Advantage	$249.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.16
Rate for Payer: Cigna Commercial	$416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH FLUNITRAZEPAM/MET CONF(S)

Facility

$832.00

Service Code	HCPCS 80300
Hospital Charge Code	397071435
Hospital Revenue Code	301
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$124.80
Rate for Payer: Qualcare PPO/HMO/WC	$124.80

CH FLUORETINE

Facility

$173.00

Service Code	HCPCS 80299
Hospital Charge Code	397073206
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH FLUORETINE

Facility

$173.00

Service Code	HCPCS 80299
Hospital Charge Code	397073206
Hospital Revenue Code	301
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

CH FLUOXETINE (PROZAC)

Facility

$344.00

Service Code	HCPCS 80299
Hospital Charge Code	397073350
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH FLUOXETINE (PROZAC)

Facility

$344.00

Service Code	HCPCS 80299
Hospital Charge Code	397073350
Hospital Revenue Code	301
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$51.60

CH FLUPHENAZINE

Facility

$195.00

Service Code	HCPCS 80299
Hospital Charge Code	397073070
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CH FLUPHENAZINE

Facility

$195.00

Service Code	HCPCS 80299
Hospital Charge Code	397073070
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH FLURAZEPAM

Facility

$225.00

Hospital Charge Code	397073071
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH FLURAZEPAM

Facility

$225.00

Hospital Charge Code	397073071
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH FOLATE, RBC

Facility

$78.00

Service Code	HCPCS 82747
Hospital Charge Code	397070019
Hospital Revenue Code	301
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH FOLATE, RBC

Facility

$78.00

Service Code	HCPCS 82747
Hospital Charge Code	397070019
Hospital Revenue Code	301
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.19
Rate for Payer: Aetna Medicare Advantage	$17.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.67
Rate for Payer: Cigna Commercial	$17.65
Rate for Payer: Cigna Medicare Advantage	$8.82
Rate for Payer: Clover Medicare Advantage	$16.77
Rate for Payer: EmblemHealth Commercial	$52.95
Rate for Payer: Humana Medicare Advantage	$18.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.71
Rate for Payer: Wellcare Medicare Advantage	$17.65

CH FOLIC ACID

Facility

$91.00

Service Code	HCPCS 82746
Hospital Charge Code	397071268
Hospital Revenue Code	301
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

CH FOLIC ACID

Facility

$91.00

Service Code	HCPCS 82746
Hospital Charge Code	397071268
Hospital Revenue Code	301
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.63
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.86
Rate for Payer: Cigna Commercial	$14.70
Rate for Payer: Cigna Medicare Advantage	$7.35
Rate for Payer: Clover Medicare Advantage	$13.96
Rate for Payer: EmblemHealth Commercial	$44.10
Rate for Payer: Humana Medicare Advantage	$15.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.58
Rate for Payer: Wellcare Medicare Advantage	$14.70

CH FOLLICLE STIMULAT HORMONE

Facility

$390.00

Service Code	HCPCS 83001
Hospital Charge Code	397071180
Hospital Revenue Code	301
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.20
Rate for Payer: Aetna Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$18.58
Rate for Payer: Cigna Medicare Advantage	$9.29
Rate for Payer: Clover Medicare Advantage	$17.65
Rate for Payer: EmblemHealth Commercial	$55.74
Rate for Payer: Humana Medicare Advantage	$19.14
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	$18.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.69
Rate for Payer: Wellcare Medicare Advantage	$18.58

CH FOLLICLE STIMULAT HORMONE

Facility

$390.00

Service Code	HCPCS 83001
Hospital Charge Code	397071180
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH FOOD ALLERGY

Facility

$342.00

Service Code	HCPCS 86003
Hospital Charge Code	397073621
Hospital Revenue Code	305
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$51.30
Rate for Payer: Qualcare PPO/HMO/WC	$51.30

CH FOOD ALLERGY

Facility

$342.00

Service Code	HCPCS 86003
Hospital Charge Code	397073621
Hospital Revenue Code	305
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

CH FRAGILE X DNA PROBE

Facility

$527.00

Service Code	HCPCS 81200
Hospital Charge Code	397071009
Hospital Revenue Code	310
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$173.12
Rate for Payer: Aetna Commercial	$153.09
Rate for Payer: Aetna Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.12
Rate for Payer: Cigna Commercial	$47.25
Rate for Payer: Cigna Medicare Advantage	$23.62
Rate for Payer: Clover Medicare Advantage	$44.89
Rate for Payer: EmblemHealth Commercial	$141.75
Rate for Payer: Humana Medicare Advantage	$48.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$50.09
Rate for Payer: Wellcare Medicare Advantage	$47.25

CH FRAGILE X DNA PROBE

Facility

$527.00

Service Code	HCPCS 81200
Hospital Charge Code	397071009
Hospital Revenue Code	310
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$79.05
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

CH FREE KAPPA LAMBDA RAND UR

Facility

$680.00

Service Code	HCPCS 83883
Hospital Charge Code	397071509
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

CH FREE KAPPA LAMBDA RAND UR

Facility

$680.00

Service Code	HCPCS 83883
Hospital Charge Code	397071509
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

CH FREE KAPPA LAMBDA (SERUM)

Facility

$680.00

Service Code	HCPCS 83883
Hospital Charge Code	397071510
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

Know your out-of-pocket cost for care.

All Charges