Heights University Hospital

All Charges

Charge

Type

Setting

Price

DRUG TEST PRESUMP CHEM ANLYZR

Facility

$390.00

Service Code	HCPCS 80307
Hospital Charge Code	39990169
Hospital Revenue Code	301
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$227.68
Rate for Payer: Aetna Commercial	$201.33
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$62.14
Rate for Payer: Cigna Medicare Advantage	$31.07
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
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
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$65.87
Rate for Payer: Wellcare Medicare Advantage	$62.14

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	39990167
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	39990167
Hospital Revenue Code	301
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.82
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.17
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: Cigna Medicare Advantage	$6.30
Rate for Payer: Clover Medicare Advantage	$11.97
Rate for Payer: EmblemHealth Commercial	$37.80
Rate for Payer: Humana Medicare Advantage	$12.98
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	$12.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.36
Rate for Payer: Wellcare Medicare Advantage	$12.60

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	3066035
Hospital Revenue Code	301
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.82
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.17
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: Cigna Medicare Advantage	$6.30
Rate for Payer: Clover Medicare Advantage	$11.97
Rate for Payer: EmblemHealth Commercial	$37.80
Rate for Payer: Humana Medicare Advantage	$12.98
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	$12.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.36
Rate for Payer: Wellcare Medicare Advantage	$12.60

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	3038545
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	3038545
Hospital Revenue Code	301
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.82
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.17
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: Cigna Medicare Advantage	$6.30
Rate for Payer: Clover Medicare Advantage	$11.97
Rate for Payer: EmblemHealth Commercial	$37.80
Rate for Payer: Humana Medicare Advantage	$12.98
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	$12.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.36
Rate for Payer: Wellcare Medicare Advantage	$12.60

DRUG TEST PRESUMP DIR OPT OBS

Facility

$390.00

Service Code	HCPCS 80305
Hospital Charge Code	3066035
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	3066036
Hospital Revenue Code	301
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.53
Rate for Payer: Aetna Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.80
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: Cigna Medicare Advantage	$8.57
Rate for Payer: Clover Medicare Advantage	$16.28
Rate for Payer: EmblemHealth Commercial	$51.42
Rate for Payer: Humana Medicare Advantage	$17.65
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	$17.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.17
Rate for Payer: Wellcare Medicare Advantage	$17.14

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	3038546
Hospital Revenue Code	301
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.53
Rate for Payer: Aetna Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.80
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: Cigna Medicare Advantage	$8.57
Rate for Payer: Clover Medicare Advantage	$16.28
Rate for Payer: EmblemHealth Commercial	$51.42
Rate for Payer: Humana Medicare Advantage	$17.65
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	$17.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.17
Rate for Payer: Wellcare Medicare Advantage	$17.14

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	3066036
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	39990168
Hospital Revenue Code	301
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.53
Rate for Payer: Aetna Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.80
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: Cigna Medicare Advantage	$8.57
Rate for Payer: Clover Medicare Advantage	$16.28
Rate for Payer: EmblemHealth Commercial	$51.42
Rate for Payer: Humana Medicare Advantage	$17.65
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	$17.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.17
Rate for Payer: Wellcare Medicare Advantage	$17.14

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	39990168
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TEST PRESUMP INSTR ASSIST

Facility

$390.00

Service Code	HCPCS 80306
Hospital Charge Code	3038546
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DRUG TOX TRAMADOL QNT URINE

Facility

$425.00

Service Code	HCPCS 80373
Hospital Charge Code	401080373
Hospital Revenue Code	301
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

DRUG TOX TRAMADOL QNT URINE

Facility

$425.00

Service Code	HCPCS 80373
Hospital Charge Code	401080373
Hospital Revenue Code	301
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

DRVVT SCREEN

Facility

$195.00

Service Code	HCPCS 85732
Hospital Charge Code	3035076B
Hospital Revenue Code	300
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	$5.61
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	$25.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
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

DRVVT SCREEN

Facility

$195.00

Service Code	HCPCS 85732
Hospital Charge Code	3035076B
Hospital Revenue Code	300
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

DRVVT SCR W/RFL PHOS NEUT

Facility

$65.80

Service Code	HCPCS 85613
Hospital Charge Code	39900181
Hospital Revenue Code	305
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$9.87
Rate for Payer: Qualcare PPO/HMO/WC	$9.87

DRVVT SCR W/RFL PHOS NEUT

Facility

$65.80

Service Code	HCPCS 85613
Hospital Charge Code	39900181
Hospital Revenue Code	305
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.04
Rate for Payer: Aetna Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.58
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	$35.10
Rate for Payer: Cigna Commercial	$9.58
Rate for Payer: Cigna Medicare Advantage	$4.79
Rate for Payer: Clover Medicare Advantage	$9.10
Rate for Payer: EmblemHealth Commercial	$28.74
Rate for Payer: Humana Medicare Advantage	$9.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.87
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.15
Rate for Payer: Wellcare Medicare Advantage	$9.58

DRY SEAL FLEX SHEATH

Facility

$3,020.00

Hospital Charge Code	270682807
Hospital Revenue Code	272
Min. Negotiated Rate	$392.60
Max. Negotiated Rate	$1,510.00
Rate for Payer: Aetna Commercial	$906.00
Rate for Payer: Aetna Medicare Advantage	$906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$770.10
Rate for Payer: Cigna Commercial	$1,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.60
Rate for Payer: Oxford Commercial	$1,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$453.00
Rate for Payer: UnitedHealthcare Commercial	$1,510.00

DRY SEAL FLEX SHEATH

Facility

$2,235.00

Hospital Charge Code	270682806
Hospital Revenue Code	272
Min. Negotiated Rate	$335.25
Max. Negotiated Rate	$335.25
Rate for Payer: Qualcare PPO/HMO/WC	$335.25

DRY SEAL FLEX SHEATH

Facility

$2,235.00

Hospital Charge Code	270682806
Hospital Revenue Code	272
Min. Negotiated Rate	$290.55
Max. Negotiated Rate	$1,117.50
Rate for Payer: Aetna Commercial	$670.50
Rate for Payer: Aetna Medicare Advantage	$670.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$569.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$569.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$569.92
Rate for Payer: Cigna Commercial	$1,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.55
Rate for Payer: Oxford Commercial	$1,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$335.25
Rate for Payer: UnitedHealthcare Commercial	$1,117.50

DRY SEAL FLEX SHEATH

Facility

$3,020.00

Hospital Charge Code	270682807
Hospital Revenue Code	272
Min. Negotiated Rate	$453.00
Max. Negotiated Rate	$453.00
Rate for Payer: Qualcare PPO/HMO/WC	$453.00

DS3A001 STRL PKG ASSY,AGILIS H

Facility

$250.00

Hospital Charge Code	270702512
Hospital Revenue Code	279
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

DS3A001 STRL PKG ASSY,AGILIS H

Facility

$250.00

Hospital Charge Code	270702512
Hospital Revenue Code	279
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges