Heights University Hospital

All Charges

Charge

Type

Setting

Price

EBV CAPSID AB (IGG)

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900235
Hospital Revenue Code	302
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.77
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.46
Rate for Payer: Cigna Commercial	$18.14
Rate for Payer: Cigna Medicare Advantage	$9.07
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
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	$18.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.23
Rate for Payer: Wellcare Medicare Advantage	$18.14

EBV DNA QUANT REAL TIME PCR

Facility

$667.59

Service Code	HCPCS 87799
Hospital Charge Code	401187799
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$156.97
Rate for Payer: Aetna Commercial	$138.80
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.97
Rate for Payer: Cigna Commercial	$42.84
Rate for Payer: Cigna Medicare Advantage	$21.42
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$45.41
Rate for Payer: Wellcare Medicare Advantage	$42.84

EBV DNA QUANT REAL TIME PCR

Facility

$667.59

Service Code	HCPCS 87799
Hospital Charge Code	401187799
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

EBV EA AB

Facility

$90.15

Service Code	HCPCS 86663
Hospital Charge Code	39900233
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.51
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
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	$48.07
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: Cigna Medicare Advantage	$6.56
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.52
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.91
Rate for Payer: Wellcare Medicare Advantage	$13.12

EBV EA AB

Facility

$90.15

Service Code	HCPCS 86663
Hospital Charge Code	39900233
Hospital Revenue Code	302
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$13.52
Rate for Payer: Qualcare PPO/HMO/WC	$13.52

EBV EA (D) AB IGG

Facility

$667.59

Service Code	HCPCS 86663
Hospital Charge Code	39900371
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

EBV EA (D) AB IGG

Facility

$667.59

Service Code	HCPCS 86663
Hospital Charge Code	39900371
Hospital Revenue Code	302
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.51
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
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	$48.07
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: Cigna Medicare Advantage	$6.56
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.91
Rate for Payer: Wellcare Medicare Advantage	$13.12

ECG DURING ECT

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84033001
Hospital Revenue Code	730
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

ECG DURING ECT

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84033001
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$197.40
Rate for Payer: Aetna Medicare Advantage	$197.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.79
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.54
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$603.00

ECG SIGNAL-AVERAGED

Facility

$571.00

Service Code	HCPCS 93278
Hospital Charge Code	5307005
Hospital Revenue Code	731
Min. Negotiated Rate	$85.65
Max. Negotiated Rate	$85.65
Rate for Payer: Qualcare PPO/HMO/WC	$85.65

ECG SIGNAL-AVERAGED

Facility

$571.00

Service Code	HCPCS 93278
Hospital Charge Code	5307005
Hospital Revenue Code	731
Min. Negotiated Rate	$74.23
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$171.30
Rate for Payer: Aetna Medicare Advantage	$171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.60
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.23
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.65
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502835
Hospital Revenue Code	730
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502630
Hospital Revenue Code	730
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$603.00

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502630
Hospital Revenue Code	730
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502835
Hospital Revenue Code	730
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$603.00

E.CHAFFEENSIS AB (IGG,M), I

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033A
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

E.CHAFFEENSIS AB (IGG,M), I

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), II

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033B
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

E.CHAFFEENSIS AB (IGG,M), II

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), III

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033C
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

E.CHAFFEENSIS AB (IGG,M), III

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), IV

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033D
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

E.CHAFFEENSIS AB (IGG,M), IV

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHINOC AB EIA REFLEX TO WBLOT

Facility

$236.16

Service Code	HCPCS 86682
Hospital Charge Code	401186682
Hospital Revenue Code	302
Min. Negotiated Rate	$35.42
Max. Negotiated Rate	$35.42
Rate for Payer: Qualcare PPO/HMO/WC	$35.42

ECHINOC AB EIA REFLEX TO WBLOT

Facility

$236.16

Service Code	HCPCS 86682
Hospital Charge Code	401186682
Hospital Revenue Code	302
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.15
Rate for Payer: Aetna Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.67
Rate for Payer: Cigna Commercial	$13.01
Rate for Payer: Cigna Medicare Advantage	$6.50
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.42
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.79
Rate for Payer: Wellcare Medicare Advantage	$13.01

Know your out-of-pocket cost for care.

All Charges