Heights University Hospital

All Charges

Charge

Type

Setting

Price

COMPLEMENT C5

Facility

$104.00

Service Code	HCPCS 86160
Hospital Charge Code	38476297
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C5

Facility

$104.00

Service Code	HCPCS 86160
Hospital Charge Code	38476297
Hospital Revenue Code	302
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

COMPLEMENT C5

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900463
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
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	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C5

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900463
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C6

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900464
Hospital Revenue Code	302
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

COMPLEMENT C6

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900464
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C7

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900465
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C7

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900465
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
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	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C8

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900466
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C8

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900466
Hospital Revenue Code	302
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

COMPLEMENT C9

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900467
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

COMPLEMENT C9

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900467
Hospital Revenue Code	302
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

COMPLEMENT TOTAL***

Facility

$69.00

Hospital Charge Code	3010857
Hospital Revenue Code	309
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

COMPLEMENT TOTAL***

Facility

$69.00

Hospital Charge Code	3010857
Hospital Revenue Code	309
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$114.00

COMPLEMENT TOTAL CH100, SERUM

Facility

$220.15

Service Code	HCPCS 86162
Hospital Charge Code	3007333
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.84
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.45
Rate for Payer: Cigna Commercial	$20.32
Rate for Payer: Cigna Medicare Advantage	$10.16
Rate for Payer: Clover Medicare Advantage	$19.30
Rate for Payer: EmblemHealth Commercial	$60.96
Rate for Payer: Humana Medicare Advantage	$20.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.54
Rate for Payer: Wellcare Medicare Advantage	$20.32

COMPLEMENT TOTAL CH100, SERUM

Facility

$220.15

Service Code	HCPCS 86162
Hospital Charge Code	3007333
Hospital Revenue Code	302
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$33.02
Rate for Payer: Qualcare PPO/HMO/WC	$33.02

COMPLEMENT TOTAL(CH50)

Facility

$220.15

Service Code	HCPCS 86162
Hospital Charge Code	3007325
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.84
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.45
Rate for Payer: Cigna Commercial	$20.32
Rate for Payer: Cigna Medicare Advantage	$10.16
Rate for Payer: Clover Medicare Advantage	$19.30
Rate for Payer: EmblemHealth Commercial	$60.96
Rate for Payer: Humana Medicare Advantage	$20.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.54
Rate for Payer: Wellcare Medicare Advantage	$20.32

COMPLEMENT TOTAL(CH50)

Facility

$220.15

Service Code	HCPCS 86162
Hospital Charge Code	3007325
Hospital Revenue Code	302
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$33.02
Rate for Payer: Qualcare PPO/HMO/WC	$33.02

COMPLEMENT, TOTAL (CH50)

Facility

$227.00

Service Code	HCPCS 86162
Hospital Charge Code	38476090
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.84
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.45
Rate for Payer: Cigna Commercial	$20.32
Rate for Payer: Cigna Medicare Advantage	$10.16
Rate for Payer: Clover Medicare Advantage	$19.30
Rate for Payer: EmblemHealth Commercial	$60.96
Rate for Payer: Humana Medicare Advantage	$20.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.54
Rate for Payer: Wellcare Medicare Advantage	$20.32

COMPLEMENT, TOTAL (CH50)

Facility

$227.00

Service Code	HCPCS 86162
Hospital Charge Code	38476090
Hospital Revenue Code	302
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

COMPLEMENT,TOTAL (CH50)

Facility

$390.00

Service Code	HCPCS 86162
Hospital Charge Code	39900197
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT,TOTAL (CH50)

Facility

$390.00

Service Code	HCPCS 86162
Hospital Charge Code	39900197
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.84
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.45
Rate for Payer: Cigna Commercial	$20.32
Rate for Payer: Cigna Medicare Advantage	$10.16
Rate for Payer: Clover Medicare Advantage	$19.30
Rate for Payer: EmblemHealth Commercial	$60.96
Rate for Payer: Humana Medicare Advantage	$20.93
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	$20.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.54
Rate for Payer: Wellcare Medicare Advantage	$20.32

COMPLERA 200MG-25MG-300MG

Facility

$470.34

Service Code	NDC 61958110101
Hospital Charge Code	6063943371
Hospital Revenue Code	250
Min. Negotiated Rate	$61.14
Max. Negotiated Rate	$235.17
Rate for Payer: Aetna Commercial	$141.10
Rate for Payer: Aetna Medicare Advantage	$141.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.94
Rate for Payer: Cigna Commercial	$235.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.14
Rate for Payer: Oxford Commercial	$235.17
Rate for Payer: Qualcare PPO/HMO/WC	$70.55
Rate for Payer: UnitedHealthcare Commercial	$235.17

COMPLERA 200MG-25MG-300MG

Facility

$470.34

Service Code	NDC 61958110101
Hospital Charge Code	6063943371
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$70.55
Rate for Payer: Qualcare PPO/HMO/WC	$70.55

COMPLETE BLOOD COUNT (CBC)

Facility

$861.62

Service Code	HCPCS 85025
Hospital Charge Code	3005402
Hospital Revenue Code	305
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$129.24
Rate for Payer: Aetna Commercial	$25.17
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: Cigna Medicare Advantage	$3.88
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.24
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.24
Rate for Payer: Wellcare Medicare Advantage	$7.77

Know your out-of-pocket cost for care.

All Charges