Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

COXSACKIE AB IV

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624D
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 IV

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624D
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 PROFILE

Facility

$614.45

Hospital Charge Code	3004835
Hospital Revenue Code	302
Min. Negotiated Rate	$92.17
Max. Negotiated Rate	$92.17
Rate for Payer: Qualcare PPO/HMO/WC	$92.17

COXSACKIE AB PROFILE

Facility

$614.45

Hospital Charge Code	3004835
Hospital Revenue Code	302
Min. Negotiated Rate	$79.88
Max. Negotiated Rate	$307.23
Rate for Payer: Aetna Commercial	$184.34
Rate for Payer: Aetna Medicare Advantage	$184.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.68
Rate for Payer: Cigna Commercial	$307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.17
Rate for Payer: UnitedHealthcare Commercial	$114.00

COXSACKIE AB V

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624E
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 V

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624E
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 VI

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624F
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 VI

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624F
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 VII

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624G
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 VII

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624G
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 VIII

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624H
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 VIII

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624H
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 B1-B6 AB I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE B1-B6 AB I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040A
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 B1-B6 AB II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE B1-B6 AB II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040B
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 B1-B6 AB III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040C
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 B1-B6 AB III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE B1-B6 AB IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE B1-B6 AB IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040D
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 B1-B6 AB V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040E
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 B1-B6 AB V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE B1-B6 AB VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040F
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 B1-B6 AB VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990040F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges