Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH RBC DEGLYCEROLIZED

Facility

$1,771.00

Service Code	HCPCS P9054
Hospital Charge Code	397031050
Hospital Revenue Code	390
Min. Negotiated Rate	$230.23
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$531.30
Rate for Payer: Aetna Medicare Advantage	$531.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.61
Rate for Payer: Cigna Commercial	$618.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.23
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.65
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC DEGLYCEROLIZED

Facility

$1,771.00

Service Code	HCPCS P9054
Hospital Charge Code	397031050
Hospital Revenue Code	390
Min. Negotiated Rate	$265.65
Max. Negotiated Rate	$265.65
Rate for Payer: Qualcare PPO/HMO/WC	$265.65

CH RBC DEGLY LEUKO IRRAD

Facility

$1,975.00

Service Code	HCPCS P9057
Hospital Charge Code	397031172
Hospital Revenue Code	390
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$985.26
Rate for Payer: Aetna Commercial	$592.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$985.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.75
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC DEGLY LEUKO IRRAD

Facility

$1,975.00

Service Code	HCPCS P9057
Hospital Charge Code	397031172
Hospital Revenue Code	390
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

CH RBC DIRECTED

Facility

$820.00

Service Code	HCPCS P9010
Hospital Charge Code	397031033
Hospital Revenue Code	390
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

CH RBC DIRECTED

Facility

$820.00

Service Code	HCPCS P9010
Hospital Charge Code	397031033
Hospital Revenue Code	390
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$246.00
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.60
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC, IRRADIATED X1

Facility

$1,302.59

Service Code	HCPCS P9038
Hospital Charge Code	397031121
Hospital Revenue Code	390
Min. Negotiated Rate	$169.34
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$390.78
Rate for Payer: Aetna Medicare Advantage	$390.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.16
Rate for Payer: Cigna Commercial	$338.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.34
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.39
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC, IRRADIATED X1

Facility

$1,302.59

Service Code	HCPCS P9038
Hospital Charge Code	397031121
Hospital Revenue Code	390
Min. Negotiated Rate	$195.39
Max. Negotiated Rate	$195.39
Rate for Payer: Qualcare PPO/HMO/WC	$195.39

CH RBC LEUKOCYTE-POOR X1

Facility

$765.00

Service Code	HCPCS P9016
Hospital Charge Code	397031125
Hospital Revenue Code	390
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$431.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC LEUKOCYTE-POOR X1

Facility

$765.00

Service Code	HCPCS P9016
Hospital Charge Code	397031125
Hospital Revenue Code	390
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$214.62
Max. Negotiated Rate	$214.62
Rate for Payer: Qualcare PPO/HMO/WC	$214.62

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$429.24
Rate for Payer: Aetna Medicare Advantage	$429.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.85
Rate for Payer: Cigna Commercial	$581.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.00
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.62
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC WASHED X1

Facility

$944.00

Hospital Charge Code	397031001
Hospital Revenue Code	390
Min. Negotiated Rate	$122.72
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$283.20
Rate for Payer: Aetna Medicare Advantage	$283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.72
Rate for Payer: Cigna Commercial	$472.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.72
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.60
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC WASHED X1

Facility

$944.00

Hospital Charge Code	397031001
Hospital Revenue Code	390
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$141.60

CH RBC X1

Facility

$899.65

Hospital Charge Code	397031007
Hospital Revenue Code	390
Min. Negotiated Rate	$116.95
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$269.89
Rate for Payer: Aetna Medicare Advantage	$269.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.41
Rate for Payer: Cigna Commercial	$449.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.95
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.95
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RBC X1

Facility

$899.65

Hospital Charge Code	397031007
Hospital Revenue Code	390
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$134.95
Rate for Payer: Qualcare PPO/HMO/WC	$134.95

CH RED BLOOD CELL IRAD LEUKO

Facility

$1,078.00

Service Code	HCPCS P9040
Hospital Charge Code	397031166
Hospital Revenue Code	390
Min. Negotiated Rate	$140.14
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$323.40
Rate for Payer: Aetna Medicare Advantage	$323.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.89
Rate for Payer: Cigna Commercial	$618.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.14
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.70
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RED BLOOD CELL IRAD LEUKO

Facility

$1,078.00

Service Code	HCPCS P9040
Hospital Charge Code	397031166
Hospital Revenue Code	390
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$161.70
Rate for Payer: Qualcare PPO/HMO/WC	$161.70

CH RED CELL WASHING

Facility

$944.00

Service Code	HCPCS P9022
Hospital Charge Code	397031027
Hospital Revenue Code	390
Min. Negotiated Rate	$122.72
Max. Negotiated Rate	$859.12
Rate for Payer: Aetna Commercial	$283.20
Rate for Payer: Aetna Medicare Advantage	$283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.72
Rate for Payer: Cigna Commercial	$859.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.72
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.60
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH RED CELL WASHING

Facility

$944.00

Service Code	HCPCS P9022
Hospital Charge Code	397031027
Hospital Revenue Code	390
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$141.60

CH REDUCING SUBSTANCE FECAL

Facility

$16.00

Service Code	HCPCS 81005
Hospital Charge Code	397071257
Hospital Revenue Code	307
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.95
Rate for Payer: Cigna Commercial	$2.17
Rate for Payer: Cigna Medicare Advantage	$1.08
Rate for Payer: Clover Medicare Advantage	$2.06
Rate for Payer: EmblemHealth Commercial	$6.51
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$2.30
Rate for Payer: Wellcare Medicare Advantage	$2.17

CH REDUCING SUBSTANCE FECAL

Facility

$16.00

Service Code	HCPCS 81005
Hospital Charge Code	397071257
Hospital Revenue Code	307
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

CH REDUCING SUGARS

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	397073022
Hospital Revenue Code	307
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.95
Rate for Payer: Cigna Commercial	$2.17
Rate for Payer: Cigna Medicare Advantage	$1.08
Rate for Payer: Clover Medicare Advantage	$2.06
Rate for Payer: EmblemHealth Commercial	$6.51
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$2.30
Rate for Payer: Wellcare Medicare Advantage	$2.17

CH REDUCING SUGARS

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	397073022
Hospital Revenue Code	307
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

CH REFERRED ANTIGEN TESTING

Facility

$260.00

Service Code	HCPCS 86902
Hospital Charge Code	397031132
Hospital Revenue Code	300
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

Know your out-of-pocket cost for care.

All Charges