Heights University Hospital

All Charges

Charge

Type

Setting

Price

E. HISTOLYTICA AB

Facility

$131.25

Service Code	HCPCS 86317
Hospital Charge Code	3006632
Hospital Revenue Code	302
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

E.HISTOLYTICA AB*****

Facility

$47.00

Service Code	HCPCS 86317
Hospital Charge Code	33006632
Hospital Revenue Code	309
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.57
Rate for Payer: Aetna Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.92
Rate for Payer: Cigna Commercial	$14.99
Rate for Payer: Cigna Medicare Advantage	$7.50
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.89
Rate for Payer: Wellcare Medicare Advantage	$14.99

E.HISTOLYTICA AB*****

Facility

$47.00

Service Code	HCPCS 86317
Hospital Charge Code	33006632
Hospital Revenue Code	309
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

E.HISTOLYTICA(AMEBIASIS), I

Facility

$75.65

Service Code	HCPCS 87337
Hospital Charge Code	39990055A
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

E.HISTOLYTICA(AMEBIASIS), I

Facility

$75.65

Service Code	HCPCS 87337
Hospital Charge Code	39990055A
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

E.HISTOLYTICA(AMEBIASIS), II

Facility

$75.65

Service Code	HCPCS 87449
Hospital Charge Code	39990055B
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

E.HISTOLYTICA(AMEBIASIS), II

Facility

$75.65

Service Code	HCPCS 87449
Hospital Charge Code	39990055B
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

E.HISTOLYTICA ANTIGEN,EIA

Facility

$390.00

Service Code	HCPCS 87337
Hospital Charge Code	39900284
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
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	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

E.HISTOLYTICA ANTIGEN,EIA

Facility

$390.00

Service Code	HCPCS 87337
Hospital Charge Code	39900284
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.HISTOLYTICA IGG

Facility

$390.00

Service Code	HCPCS 86753
Hospital Charge Code	39900251
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.HISTOLYTICA IGG

Facility

$390.00

Service Code	HCPCS 86753
Hospital Charge Code	39900251
Hospital Revenue Code	302
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.14
Rate for Payer: Aetna Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.40
Rate for Payer: Cigna Commercial	$12.39
Rate for Payer: Cigna Medicare Advantage	$6.20
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
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	$12.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.13
Rate for Payer: Wellcare Medicare Advantage	$12.39

EHRLICHHIACHAFFEENSISDNARTPCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	4011877984
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EHRLICHHIACHAFFEENSISDNARTPCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	4011877984
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74116007
Hospital Revenue Code	730
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$121.37
Rate for Payer: Qualcare PPO/HMO/WC	$121.37

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74116007
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$242.75
Rate for Payer: Aetna Medicare Advantage	$242.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.33
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	$206.33
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.19
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.37
Rate for Payer: UnitedHealthcare Commercial	$603.00

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74117007
Hospital Revenue Code	730
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$121.37
Rate for Payer: Qualcare PPO/HMO/WC	$121.37

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74117007
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$242.75
Rate for Payer: Aetna Medicare Advantage	$242.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.33
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	$206.33
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.19
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.37
Rate for Payer: UnitedHealthcare Commercial	$603.00

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74115007
Hospital Revenue Code	730
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$121.37
Rate for Payer: Qualcare PPO/HMO/WC	$121.37

EKG 12 LEAD

Facility

$809.15

Service Code	HCPCS 93005
Hospital Charge Code	74115007
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$242.75
Rate for Payer: Aetna Medicare Advantage	$242.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.33
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	$206.33
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.19
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$121.37
Rate for Payer: UnitedHealthcare Commercial	$603.00

EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	36540001
Hospital Revenue Code	730
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	36540001
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$615.00
Rate for Payer: Aetna Commercial	$615.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
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	$522.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.50
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$603.00

EKG AHA LEADWIRES 5-SET

Facility

$337.50

Hospital Charge Code	2709002961
Hospital Revenue Code	272
Min. Negotiated Rate	$50.62
Max. Negotiated Rate	$50.62
Rate for Payer: Qualcare PPO/HMO/WC	$50.62

EKG AHA LEADWIRES 5-SET

Facility

$337.50

Hospital Charge Code	2709002961
Hospital Revenue Code	272
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna Commercial	$101.25
Rate for Payer: Aetna Medicare Advantage	$101.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.06
Rate for Payer: Cigna Commercial	$168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.88
Rate for Payer: Oxford Commercial	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$50.62
Rate for Payer: UnitedHealthcare Commercial	$168.75

EKG RHYTHM STRIP W/O INTERPR**

Facility

$10.80

Service Code	HCPCS 93041
Hospital Charge Code	5300018
Hospital Revenue Code	730
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$603.00

EKG RHYTHM STRIP W/O INTERPR**

Facility

$10.80

Service Code	HCPCS 93041
Hospital Charge Code	5300018
Hospital Revenue Code	730
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

Know your out-of-pocket cost for care.

All Charges