Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH SELENIUM

Facility

$883.27

Service Code	HCPCS 84255
Hospital Charge Code	397071434
Hospital Revenue Code	301
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$132.49
Rate for Payer: Qualcare PPO/HMO/WC	$132.49

CH SELENIUM

Facility

$883.27

Service Code	HCPCS 84255
Hospital Charge Code	397071434
Hospital Revenue Code	301
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$132.49
Rate for Payer: Aetna Commercial	$82.72
Rate for Payer: Aetna Medicare Advantage	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.54
Rate for Payer: Cigna Commercial	$25.53
Rate for Payer: Cigna Medicare Advantage	$12.77
Rate for Payer: Clover Medicare Advantage	$24.25
Rate for Payer: EmblemHealth Commercial	$76.59
Rate for Payer: Humana Medicare Advantage	$26.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.06
Rate for Payer: Wellcare Medicare Advantage	$25.53

CH SEMEN ANALYSIS

Facility

$214.00

Service Code	HCPCS 89320
Hospital Charge Code	397021046
Hospital Revenue Code	300
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

CH SEMEN ANALYSIS

Facility

$214.00

Service Code	HCPCS 89320
Hospital Charge Code	397021046
Hospital Revenue Code	300
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$12.31
Rate for Payer: Cigna Medicare Advantage	$6.16
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.05
Rate for Payer: Wellcare Medicare Advantage	$12.31

CH SEPARATION

Facility

$162.00

Service Code	HCPCS 83894
Hospital Charge Code	397073562
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH SEPARATION

Facility

$162.00

Service Code	HCPCS 83894
Hospital Charge Code	397073562
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 SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073289
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073289
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 SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073296
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 SEPARATION X2

Facility

$65.00

Service Code	HCPCS 83894
Hospital Charge Code	397073296
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH SEPARATION X3

Facility

$40.00

Service Code	HCPCS 83894
Hospital Charge Code	397073282
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CH SEPARATION X3

Facility

$40.00

Service Code	HCPCS 83894
Hospital Charge Code	397073282
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 SEROQUEL

Facility

$258.00

Service Code	HCPCS 80299
Hospital Charge Code	397073204
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH SEROQUEL

Facility

$258.00

Service Code	HCPCS 80299
Hospital Charge Code	397073204
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	$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	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH SEROTONIN

Facility

$1,671.00

Service Code	HCPCS 84260
Hospital Charge Code	397071011
Hospital Revenue Code	301
Min. Negotiated Rate	$250.65
Max. Negotiated Rate	$250.65
Rate for Payer: Qualcare PPO/HMO/WC	$250.65

CH SEROTONIN

Facility

$1,671.00

Service Code	HCPCS 84260
Hospital Charge Code	397071011
Hospital Revenue Code	301
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$250.65
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.51
Rate for Payer: Cigna Commercial	$30.98
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$32.84
Rate for Payer: Wellcare Medicare Advantage	$30.98

CH SEX HORMONE BINDING GLOBU

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	397072124
Hospital Revenue Code	301
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.41
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.62
Rate for Payer: Cigna Commercial	$21.73
Rate for Payer: Cigna Medicare Advantage	$10.87
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.03
Rate for Payer: Wellcare Medicare Advantage	$21.73

CH SEX HORMONE BINDING GLOBU

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	397072124
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

CH SHIGA-LIKE TOXIN AG EIA

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	397071491
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
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	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
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	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

CH SHIGA-LIKE TOXIN AG EIA

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	397071491
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SICKLE CELL TEST

Facility

$390.00

Service Code	HCPCS 85660
Hospital Charge Code	397021056
Hospital Revenue Code	305
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.85
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.19
Rate for Payer: Cigna Commercial	$5.51
Rate for Payer: Cigna Medicare Advantage	$2.75
Rate for Payer: Clover Medicare Advantage	$5.23
Rate for Payer: EmblemHealth Commercial	$16.53
Rate for Payer: Humana Medicare Advantage	$5.68
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	$5.51
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.84
Rate for Payer: Wellcare Medicare Advantage	$5.51

CH SICKLE CELL TEST

Facility

$60.00

Service Code	HCPCS 8566091
Hospital Charge Code	397034882
Hospital Revenue Code	305
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH SICKLE CELL TEST

Facility

$390.00

Service Code	HCPCS 85660
Hospital Charge Code	397021056
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SICKLE CELL TEST

Facility

$60.00

Service Code	HCPCS 8566091
Hospital Charge Code	397034882
Hospital Revenue Code	305
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

CH SMEAR COMPLEX STAIN

Facility

$107.00

Service Code	HCPCS 87209
Hospital Charge Code	397071451
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

Know your out-of-pocket cost for care.

All Charges