Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH T3 FREE

Facility

$278.00

Service Code	HCPCS 84481
Hospital Charge Code	397072016
Hospital Revenue Code	301
Min. Negotiated Rate	$41.70
Max. Negotiated Rate	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$41.70

CH T3 FREE

Facility

$278.00

Service Code	HCPCS 84481
Hospital Charge Code	397072016
Hospital Revenue Code	301
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.89
Rate for Payer: Aetna Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.07
Rate for Payer: Cigna Commercial	$16.94
Rate for Payer: Cigna Medicare Advantage	$8.47
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.96
Rate for Payer: Wellcare Medicare Advantage	$16.94

CH T3 FREE, TRACER DIALYSIS

Facility

$101.00

Service Code	HCPCS 84481
Hospital Charge Code	397071465
Hospital Revenue Code	301
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.89
Rate for Payer: Aetna Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.07
Rate for Payer: Cigna Commercial	$16.94
Rate for Payer: Cigna Medicare Advantage	$8.47
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.96
Rate for Payer: Wellcare Medicare Advantage	$16.94

CH T3 FREE, TRACER DIALYSIS

Facility

$101.00

Service Code	HCPCS 84481
Hospital Charge Code	397071465
Hospital Revenue Code	301
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

CH T3, REVERSE

Facility

$44.00

Service Code	HCPCS 84482
Hospital Charge Code	397070003
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CH T3, REVERSE

Facility

$44.00

Service Code	HCPCS 84482
Hospital Charge Code	397070003
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$51.06
Rate for Payer: Aetna Medicare Advantage	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.74
Rate for Payer: Cigna Commercial	$15.76
Rate for Payer: Cigna Medicare Advantage	$7.88
Rate for Payer: Clover Medicare Advantage	$14.97
Rate for Payer: EmblemHealth Commercial	$47.28
Rate for Payer: Humana Medicare Advantage	$16.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.71
Rate for Payer: Wellcare Medicare Advantage	$15.76

CH T3 TOTAL

Facility

$161.00

Service Code	HCPCS 84480
Hospital Charge Code	397071007
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

CH T3 TOTAL

Facility

$161.00

Service Code	HCPCS 84480
Hospital Charge Code	397071007
Hospital Revenue Code	301
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

CH T3 UPTAKE

Facility

$113.00

Service Code	HCPCS 84479
Hospital Charge Code	397071313
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

CH T3 UPTAKE

Facility

$113.00

Service Code	HCPCS 84479
Hospital Charge Code	397071313
Hospital Revenue Code	301
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

CH T4, FREE

Facility

$453.00

Service Code	HCPCS 84439
Hospital Charge Code	397071318
Hospital Revenue Code	301
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

CH T4, FREE

Facility

$453.00

Service Code	HCPCS 84439
Hospital Charge Code	397071318
Hospital Revenue Code	301
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.22
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
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	$33.05
Rate for Payer: Cigna Commercial	$9.02
Rate for Payer: Cigna Medicare Advantage	$4.51
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.56
Rate for Payer: Wellcare Medicare Advantage	$9.02

CH T4, TOTAL

Facility

$282.00

Service Code	HCPCS 84436
Hospital Charge Code	397071159
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

CH T4, TOTAL

Facility

$282.00

Service Code	HCPCS 84436
Hospital Charge Code	397071159
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.26
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.17
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: Cigna Medicare Advantage	$3.44
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.28
Rate for Payer: Wellcare Medicare Advantage	$6.87

CH TACROLIMUS

Facility

$208.00

Service Code	HCPCS 80197
Hospital Charge Code	397072153
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

CH TACROLIMUS

Facility

$208.00

Service Code	HCPCS 80197
Hospital Charge Code	397072153
Hospital Revenue Code	301
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.49
Rate for Payer: Aetna Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.31
Rate for Payer: Cigna Commercial	$13.73
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.55
Rate for Payer: Wellcare Medicare Advantage	$13.73

CH TARTRATE RES ACP

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397073116
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH TARTRATE RES ACP

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397073116
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH T CELLS TOTAL

Facility

$78.00

Service Code	HCPCS 86359
Hospital Charge Code	397073306
Hospital Revenue Code	302
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH T CELLS TOTAL

Facility

$78.00

Service Code	HCPCS 86359
Hospital Charge Code	397073306
Hospital Revenue Code	302
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$138.24
Rate for Payer: Aetna Commercial	$122.25
Rate for Payer: Aetna Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.24
Rate for Payer: Cigna Commercial	$37.73
Rate for Payer: Cigna Medicare Advantage	$18.86
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
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	$37.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$39.99
Rate for Payer: Wellcare Medicare Advantage	$37.73

CH TERM DEOXYN TRANS

Facility

$531.00

Service Code	HCPCS 88346
Hospital Charge Code	397073160
Hospital Revenue Code	312
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$159.30
Rate for Payer: Aetna Medicare Advantage	$159.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.41
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$78.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH TERM DEOXYN TRANS

Facility

$531.00

Service Code	HCPCS 88346
Hospital Charge Code	397073160
Hospital Revenue Code	312
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$79.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.65

CH TESTOSTERONE

Facility

$293.00

Service Code	HCPCS 84403
Hospital Charge Code	397071320
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

CH TESTOSTERONE

Facility

$293.00

Service Code	HCPCS 84403
Hospital Charge Code	397071320
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$83.62
Rate for Payer: Aetna Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$25.81
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.36
Rate for Payer: Wellcare Medicare Advantage	$25.81

CH TESTOSTERONE FREE

Facility

$180.00

Service Code	HCPCS 84402
Hospital Charge Code	397073302
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.52
Rate for Payer: Aetna Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.32
Rate for Payer: Cigna Commercial	$25.47
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
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
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.00
Rate for Payer: Wellcare Medicare Advantage	$25.47

Know your out-of-pocket cost for care.

All Charges