Heights University Hospital

All Charges

Charge

Type

Setting

Price

FILARIASIS

Facility

$133.65

Service Code	HCPCS 87207
Hospital Charge Code	3000188
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.95
Rate for Payer: Cigna Commercial	$5.99
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.35
Rate for Payer: Wellcare Medicare Advantage	$5.99

FILARIASIS,BLOOD

Facility

$162.00

Service Code	HCPCS 87207
Hospital Charge Code	38475093
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.95
Rate for Payer: Cigna Commercial	$5.99
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.35
Rate for Payer: Wellcare Medicare Advantage	$5.99

FILARIASIS,BLOOD

Facility

$162.00

Service Code	HCPCS 87207
Hospital Charge Code	38475093
Hospital Revenue Code	309
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

FI LAS 365 MIC HOL DHBFSF365DO

Facility

$1,050.00

Hospital Charge Code	270639739
Hospital Revenue Code	272
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

FI LAS 365 MIC HOL DHBFSF365DO

Facility

$1,050.00

Hospital Charge Code	270639739
Hospital Revenue Code	272
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$525.00

FILGRASTIM 300 MCG INJ

Facility

$3,859.20

Service Code	HCPCS J1442
Hospital Charge Code	60630226
Hospital Revenue Code	636
Min. Negotiated Rate	$578.88
Max. Negotiated Rate	$933.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$933.93
Rate for Payer: Qualcare PPO/HMO/WC	$578.88

FILGRASTIM 300 MCG INJ

Facility

$2,423.59

Service Code	HCPCS J1442
Hospital Charge Code	60627535
Hospital Revenue Code	636
Min. Negotiated Rate	$363.54
Max. Negotiated Rate	$727.08
Rate for Payer: Aetna Commercial	$727.08
Rate for Payer: Aetna Medicare Advantage	$727.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$618.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$618.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$618.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.54

FILGRASTIM 300 MCG INJ

Facility

$2,423.59

Service Code	HCPCS J1442
Hospital Charge Code	60627535
Hospital Revenue Code	636
Min. Negotiated Rate	$363.54
Max. Negotiated Rate	$586.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.54

FILGRASTIM 300 MCG INJ

Facility

$3,859.20

Service Code	HCPCS J1442
Hospital Charge Code	60630226
Hospital Revenue Code	636
Min. Negotiated Rate	$578.88
Max. Negotiated Rate	$1,157.76
Rate for Payer: Aetna Commercial	$1,157.76
Rate for Payer: Aetna Medicare Advantage	$1,157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$933.93
Rate for Payer: Qualcare PPO/HMO/WC	$578.88

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.00

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$79.73
Max. Negotiated Rate	$306.65
Rate for Payer: Aetna Commercial	$183.99
Rate for Payer: Aetna Medicare Advantage	$183.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.39
Rate for Payer: Cigna Commercial	$306.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.73
Rate for Payer: Oxford Commercial	$306.65
Rate for Payer: Qualcare PPO/HMO/WC	$92.00
Rate for Payer: UnitedHealthcare Commercial	$306.65

FILIFORM SPIRAL TIP 4Fr 022104

Facility

$355.00

Hospital Charge Code	270653445
Hospital Revenue Code	272
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$53.25
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

FILIFORM SPIRAL TIP 4Fr 022104

Facility

$355.00

Hospital Charge Code	270653445
Hospital Revenue Code	272
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.15
Rate for Payer: Oxford Commercial	$177.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Commercial	$177.50

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$40.52
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.56
Rate for Payer: Oxford Commercial	$67.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$67.53

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$40.52
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.56
Rate for Payer: Oxford Commercial	$67.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$67.53

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM STR TIP 18 6F

Facility

$211.25

Hospital Charge Code	270619887
Hospital Revenue Code	272
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$31.69

FILIFORM STR TIP 18 6F

Facility

$211.25

Hospital Charge Code	270619887
Hospital Revenue Code	272
Min. Negotiated Rate	$27.46
Max. Negotiated Rate	$105.62
Rate for Payer: Aetna Commercial	$63.38
Rate for Payer: Aetna Medicare Advantage	$63.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.87
Rate for Payer: Cigna Commercial	$105.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.46
Rate for Payer: Oxford Commercial	$105.62
Rate for Payer: Qualcare PPO/HMO/WC	$31.69
Rate for Payer: UnitedHealthcare Commercial	$105.62

FILIFORM STR TIP 5FR

Facility

$380.00

Hospital Charge Code	270600276
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

FILIFORM STR TIP 5FR

Facility

$380.00

Hospital Charge Code	270600276
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

FILIFORM STR TIP LNG 4FR

Facility

$414.45

Hospital Charge Code	270600277
Hospital Revenue Code	272
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

FILIFORM STR TIP LNG 4FR

Facility

$414.45

Hospital Charge Code	270600277
Hospital Revenue Code	272
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$207.22
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$207.22

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$97.88
Max. Negotiated Rate	$97.88
Rate for Payer: Qualcare PPO/HMO/WC	$97.88

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$84.83
Max. Negotiated Rate	$326.25
Rate for Payer: Aetna Commercial	$195.75
Rate for Payer: Aetna Medicare Advantage	$195.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.39
Rate for Payer: Cigna Commercial	$326.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.83
Rate for Payer: Oxford Commercial	$326.25
Rate for Payer: Qualcare PPO/HMO/WC	$97.88
Rate for Payer: UnitedHealthcare Commercial	$326.25

Know your out-of-pocket cost for care.

All Charges