Heights University Hospital

All Charges

Charge

Type

Setting

Price

HD FEM BIOLOX D OPT 28MM OD

Facility

$8,286.00

Service Code	HCPCS C1776
Hospital Charge Code	270697542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.90
Max. Negotiated Rate	$4,143.00
Rate for Payer: Aetna Commercial	$2,485.80
Rate for Payer: Aetna Medicare Advantage	$2,485.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,112.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,112.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,657.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,112.93
Rate for Payer: Cigna Commercial	$4,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,005.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.90

HDL CHOLESTEROL

Facility

$390.00

Service Code	HCPCS 83718
Hospital Charge Code	3030194
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HDL CHOLESTEROL

Facility

$390.00

Service Code	HCPCS 83718
Hospital Charge Code	3030194
Hospital Revenue Code	301
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.54
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
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	$30.01
Rate for Payer: Cigna Commercial	$8.19
Rate for Payer: Cigna Medicare Advantage	$4.09
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
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	$8.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.68
Rate for Payer: Wellcare Medicare Advantage	$8.19

HDL CHOLESTEROL PANEL

Facility

$39.60

Service Code	HCPCS 83718
Hospital Charge Code	3030194P
Hospital Revenue Code	301
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.54
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
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	$30.01
Rate for Payer: Cigna Commercial	$8.19
Rate for Payer: Cigna Medicare Advantage	$4.09
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.94
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.68
Rate for Payer: Wellcare Medicare Advantage	$8.19

HDL CHOLESTEROL PANEL

Facility

$39.60

Service Code	HCPCS 83718
Hospital Charge Code	3030194P
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.94

HDL CHOLESTEROL PANEL***

Facility

$30.00

Service Code	HCPCS 83718
Hospital Charge Code	30301394P
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

HDL CHOLESTEROL PANEL***

Facility

$30.00

Service Code	HCPCS 83718
Hospital Charge Code	30301394P
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.54
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
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	$30.01
Rate for Payer: Cigna Commercial	$8.19
Rate for Payer: Cigna Medicare Advantage	$4.09
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.68
Rate for Payer: Wellcare Medicare Advantage	$8.19

HD MODLR 58mm M2A MAGNM 157458

Facility

$6,140.00

Hospital Charge Code	270639185
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$1,842.00
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

HD MODLR 58mm M2A MAGNM 157458

Facility

$6,140.00

Hospital Charge Code	270639185
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

HD SCORPION NEEDLE

Facility

$1,000.00

Hospital Charge Code	270702938
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

HD SCORPION NEEDLE

Facility

$1,000.00

Hospital Charge Code	270702938
Hospital Revenue Code	270
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

HDV AB

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3035154
Hospital Revenue Code	302
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.60
Rate for Payer: Aetna Medicare Advantage	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.87
Rate for Payer: Cigna Commercial	$17.16
Rate for Payer: Cigna Medicare Advantage	$8.58
Rate for Payer: Clover Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$51.48
Rate for Payer: Humana Medicare Advantage	$17.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.16
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.19
Rate for Payer: Wellcare Medicare Advantage	$17.16

HDV AB

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3035154
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HE4 OVARIAN CA

Facility

$143.05

Service Code	HCPCS 86305
Hospital Charge Code	39900208
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

HE4 OVARIAN CA

Facility

$143.05

Service Code	HCPCS 86305
Hospital Charge Code	39900208
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$20.81
Rate for Payer: Cigna Medicare Advantage	$10.40
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.06
Rate for Payer: Wellcare Medicare Advantage	$20.81

HE4 OVARIAN CANCER MONITORING

Facility

$390.00

Service Code	HCPCS 86305
Hospital Charge Code	401086305
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HE4 OVARIAN CANCER MONITORING

Facility

$390.00

Service Code	HCPCS 86305
Hospital Charge Code	401086305
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$20.81
Rate for Payer: Cigna Medicare Advantage	$10.40
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
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	$20.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.06
Rate for Payer: Wellcare Medicare Advantage	$20.81

HE AB IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035070
Hospital Revenue Code	300
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$443.55
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$443.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

HE AB IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035070
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HE AB IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035069
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HE AB IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035069
Hospital Revenue Code	300
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$443.55
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$443.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

HEAD 28 MM C-TAPER +5 OFFSET

Facility

$4,277.35

Service Code	HCPCS C1776
Hospital Charge Code	270682463
Hospital Revenue Code	278
Min. Negotiated Rate	$641.60
Max. Negotiated Rate	$1,035.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.12
Rate for Payer: Qualcare PPO/HMO/WC	$641.60

HEAD 28 MM C-TAPER +5 OFFSET

Facility

$4,277.35

Service Code	HCPCS C1776
Hospital Charge Code	270682463
Hospital Revenue Code	278
Min. Negotiated Rate	$641.60
Max. Negotiated Rate	$2,138.68
Rate for Payer: Aetna Commercial	$1,283.20
Rate for Payer: Aetna Medicare Advantage	$1,283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.72
Rate for Payer: Cigna Commercial	$2,138.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.12
Rate for Payer: Qualcare PPO/HMO/WC	$641.60

HEAD 28MM MORSE TAPER +0

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682465
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$2,444.00
Rate for Payer: Aetna Commercial	$1,466.40
Rate for Payer: Aetna Medicare Advantage	$1,466.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.44
Rate for Payer: Cigna Commercial	$2,444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

HEAD 28MM MORSE TAPER +0

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682465
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$1,182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

Know your out-of-pocket cost for care.

All Charges