Heights University Hospital

All Charges

Charge

Type

Setting

Price

COVER VERTEB BODY LOCKING 6MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694366
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVER VERTEB BODY LOCKING 6MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694366
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
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) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVID19 AMPLIFIED PROBE TECHNI

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635
Hospital Revenue Code	306
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$188.00
Rate for Payer: Aetna Commercial	$166.24
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.00
Rate for Payer: Cigna Commercial	$51.31
Rate for Payer: Cigna Medicare Advantage	$25.66
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$54.39
Rate for Payer: Wellcare Medicare Advantage	$51.31

COVID19 AMPLIFIED PROBE TECHNI

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 QL REAL TIME RT-PCR

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 QL REAL TIME RT-PCR

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635A
Hospital Revenue Code	306
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$188.00
Rate for Payer: Aetna Commercial	$166.24
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.00
Rate for Payer: Cigna Commercial	$51.31
Rate for Payer: Cigna Medicare Advantage	$25.66
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$54.39
Rate for Payer: Wellcare Medicare Advantage	$51.31

COVID19 RNA PCR CEPHEID

Facility

$387.00

Service Code	HCPCS 87635QW
Hospital Charge Code	401187635A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 RNA PCR CEPHEID

Facility

$387.00

Service Code	HCPCS 87635QW
Hospital Charge Code	401187635A
Hospital Revenue Code	306
Min. Negotiated Rate	$50.31
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$116.10
Rate for Payer: Aetna Medicare Advantage	$116.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.69
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$114.00

COXSACKIE A AB (2,4,7,9,1 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE A AB (2,4,7,9,1 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE A AB (2,4,7,9,1 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039C
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE A AB (2,4,7,9,1 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039D
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE A AB (2,4,7,9,1 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039E
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE A AB (2,4,7,9,1 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039F
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

COXSACKIE AB I

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.22
Rate for Payer: Aetna Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.74
Rate for Payer: Cigna Commercial	$13.03
Rate for Payer: Cigna Medicare Advantage	$6.51
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.81
Rate for Payer: Wellcare Medicare Advantage	$13.03

COXSACKIE AB I

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624A
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

COXSACKIE AB II

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

COXSACKIE AB II

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624B
Hospital Revenue Code	302
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.22
Rate for Payer: Aetna Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.74
Rate for Payer: Cigna Commercial	$13.03
Rate for Payer: Cigna Medicare Advantage	$6.51
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.81
Rate for Payer: Wellcare Medicare Advantage	$13.03

COXSACKIE AB III

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624C
Hospital Revenue Code	302
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.22
Rate for Payer: Aetna Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.74
Rate for Payer: Cigna Commercial	$13.03
Rate for Payer: Cigna Medicare Advantage	$6.51
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.81
Rate for Payer: Wellcare Medicare Advantage	$13.03

Know your out-of-pocket cost for care.

All Charges