Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH LEVEL 3 - GROSS & MICRO

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	397061021
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

CH LEVEL 3 - GROSS & MICRO

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	397061021
Hospital Revenue Code	310
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$262.08
Rate for Payer: Aetna Commercial	$262.08
Rate for Payer: Aetna Medicare Advantage	$262.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.77
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$23.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 3-GROSS & MICRO-ADD

Facility

$624.00

Service Code	HCPCS 8830491
Hospital Charge Code	397061085
Hospital Revenue Code	310
Min. Negotiated Rate	$81.12
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$187.20
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 3-GROSS & MICRO-ADD

Facility

$624.00

Service Code	HCPCS 8830491
Hospital Charge Code	397061085
Hospital Revenue Code	310
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$93.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

CH LEVEL 4 - GROSS & MICRO

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	397061074
Hospital Revenue Code	310
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

CH LEVEL 4 - GROSS & MICRO

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	397061074
Hospital Revenue Code	310
Min. Negotiated Rate	$89.97
Max. Negotiated Rate	$346.05
Rate for Payer: Aetna Commercial	$207.63
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$346.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 4-GROSS & MICRO-ADD

Facility

$970.00

Service Code	HCPCS 8830591
Hospital Charge Code	397061086
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$485.00
Rate for Payer: Aetna Commercial	$291.00
Rate for Payer: Aetna Medicare Advantage	$291.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.35
Rate for Payer: Cigna Commercial	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$145.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 4-GROSS & MICRO-ADD

Facility

$970.00

Service Code	HCPCS 8830591
Hospital Charge Code	397061086
Hospital Revenue Code	310
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$145.50
Rate for Payer: Qualcare PPO/HMO/WC	$145.50

CH LEVEL 5 - GROSS & MICRO

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	397061023
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$329.70
Rate for Payer: Aetna Medicare Advantage	$329.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.25
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$158.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 5 - GROSS & MICRO

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	397061023
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

CH LEVEL 5-GROSS & MICRO-ADD

Facility

$551.00

Service Code	HCPCS 8830791
Hospital Charge Code	397061087
Hospital Revenue Code	310
Min. Negotiated Rate	$71.63
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.50
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVEL 5-GROSS & MICRO-ADD

Facility

$551.00

Service Code	HCPCS 8830791
Hospital Charge Code	397061087
Hospital Revenue Code	310
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

CH LEVEL 6 - GROSS & MICRO

Facility

$500.00

Service Code	HCPCS 88309
Hospital Charge Code	397061024
Hospital Revenue Code	310
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CH LEVEL 6 - GROSS & MICRO

Facility

$500.00

Service Code	HCPCS 88309
Hospital Charge Code	397061024
Hospital Revenue Code	310
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$235.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH LEVETIRACETAM

Facility

$164.00

Service Code	HCPCS 80299
Hospital Charge Code	397073595
Hospital Revenue Code	301
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

CH LEVETIRACETAM

Facility

$164.00

Service Code	HCPCS 80299
Hospital Charge Code	397073595
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	$21.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
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 LIDOCAINE

Facility

$258.00

Service Code	HCPCS 80176
Hospital Charge Code	397071057
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH LIDOCAINE

Facility

$258.00

Service Code	HCPCS 80176
Hospital Charge Code	397071057
Hospital Revenue Code	301
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.60
Rate for Payer: Aetna Medicare Advantage	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.69
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	$53.82
Rate for Payer: Cigna Commercial	$14.69
Rate for Payer: Cigna Medicare Advantage	$7.34
Rate for Payer: Clover Medicare Advantage	$13.96
Rate for Payer: EmblemHealth Commercial	$44.07
Rate for Payer: Humana Medicare Advantage	$15.13
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	$14.69
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.57
Rate for Payer: Wellcare Medicare Advantage	$14.69

CH LIGHT CHAINS KAPPA

Facility

$961.00

Service Code	HCPCS 83883
Hospital Charge Code	397073161
Hospital Revenue Code	301
Min. Negotiated Rate	$144.15
Max. Negotiated Rate	$144.15
Rate for Payer: Qualcare PPO/HMO/WC	$144.15

CH LIGHT CHAINS KAPPA

Facility

$961.00

Service Code	HCPCS 83883
Hospital Charge Code	397073161
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	$124.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.15
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 LIGHT CHAINS LAMBDA

Facility

$961.00

Service Code	HCPCS 83883
Hospital Charge Code	397073162
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	$124.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.15
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 LIGHT CHAINS LAMBDA

Facility

$961.00

Service Code	HCPCS 83883
Hospital Charge Code	397073162
Hospital Revenue Code	301
Min. Negotiated Rate	$144.15
Max. Negotiated Rate	$144.15
Rate for Payer: Qualcare PPO/HMO/WC	$144.15

CH LIGHT CHAIN TYPE URINE

Facility

$123.00

Service Code	HCPCS 83883
Hospital Charge Code	397071343
Hospital Revenue Code	301
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

CH LIGHT CHAIN TYPE URINE

Facility

$123.00

Service Code	HCPCS 83883
Hospital Charge Code	397071343
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	$15.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
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 LIPASE

Facility

$462.12

Service Code	HCPCS 83690
Hospital Charge Code	397071033
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.32
Rate for Payer: Aetna Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.24
Rate for Payer: Cigna Commercial	$6.89
Rate for Payer: Cigna Medicare Advantage	$3.44
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.32
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.30
Rate for Payer: Wellcare Medicare Advantage	$6.89

Know your out-of-pocket cost for care.

All Charges