Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$131.40
Rate for Payer: Qualcare PPO/HMO/WC	$131.40

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$228.14
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	$228.14
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	$113.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.40
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

HEPATITIS C RIBA RECOMBINANT

Facility

$383.25

Service Code	HCPCS 86803
Hospital Charge Code	3009875
Hospital Revenue Code	302
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.23
Rate for Payer: Aetna Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.29
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: Cigna Medicare Advantage	$7.13
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.13
Rate for Payer: Wellcare Medicare Advantage	$14.27

HEPATITIS C RIBA RECOMBINANT

Facility

$383.25

Service Code	HCPCS 86803
Hospital Charge Code	3009875
Hospital Revenue Code	302
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RNA AMP PROBE

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009388
Hospital Revenue Code	306
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RNA AMP PROBE

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009388
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$228.14
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	$228.14
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	$49.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
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

HEPATITIS C RNA, PCR

Facility

$2,335.00

Service Code	HCPCS 87522
Hospital Charge Code	38475107
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$350.25
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	$228.14
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	$303.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$350.25
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

HEPATITIS C RNA, PCR

Facility

$2,335.00

Service Code	HCPCS 87522
Hospital Charge Code	38475107
Hospital Revenue Code	306
Min. Negotiated Rate	$350.25
Max. Negotiated Rate	$350.25
Rate for Payer: Qualcare PPO/HMO/WC	$350.25

HEPATITIS C,RNA,PCR,QUAL

Facility

$1,853.00

Service Code	HCPCS 87521
Hospital Charge Code	38475111
Hospital Revenue Code	306
Min. Negotiated Rate	$277.95
Max. Negotiated Rate	$277.95
Rate for Payer: Qualcare PPO/HMO/WC	$277.95

HEPATITIS C,RNA,PCR,QUAL

Facility

$1,853.00

Service Code	HCPCS 87521
Hospital Charge Code	38475111
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$277.95
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	$71.06
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	$240.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.95
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

HEPATITIS C RNA (PCR QUANT)

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009387
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$228.14
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	$228.14
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	$49.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
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

HEPATITIS C RNA (PCR QUANT)

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009387
Hospital Revenue Code	306
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RNA QUANT WITH REF

Facility

$294.40

Service Code	HCPCS 87522
Hospital Charge Code	39900459
Hospital Revenue Code	306
Min. Negotiated Rate	$44.16
Max. Negotiated Rate	$44.16
Rate for Payer: Qualcare PPO/HMO/WC	$44.16

HEPATITIS C RNA QUANT WITH REF

Facility

$294.40

Service Code	HCPCS 87522
Hospital Charge Code	39900459
Hospital Revenue Code	306
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$228.14
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	$228.14
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	$38.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.16
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

HEPATITIS C VIRAL RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87521
Hospital Charge Code	38479740
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
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	$71.06
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

HEPATITIS C VIRAL RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87521
Hospital Charge Code	38479740
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS C VIRUS

Facility

$2,584.20

Service Code	HCPCS 87902
Hospital Charge Code	3036004
Hospital Revenue Code	306
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$943.30
Rate for Payer: Aetna Commercial	$834.14
Rate for Payer: Aetna Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$943.30
Rate for Payer: Cigna Commercial	$257.45
Rate for Payer: Cigna Medicare Advantage	$128.72
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$387.63
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$272.90
Rate for Payer: Wellcare Medicare Advantage	$257.45

HEPATITIS C VIRUS

Facility

$2,584.20

Service Code	HCPCS 87902
Hospital Charge Code	3036004
Hospital Revenue Code	306
Min. Negotiated Rate	$387.63
Max. Negotiated Rate	$387.63
Rate for Payer: Qualcare PPO/HMO/WC	$387.63

HEPATITIS-D AB (DELTA)

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3032174
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HEPATITIS-D AB (DELTA)

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3032174
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

HEPATITIS D AB,TOTAL

Facility

$390.00

Service Code	HCPCS 86692
Hospital Charge Code	39900240
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS D AB,TOTAL

Facility

$390.00

Service Code	HCPCS 86692
Hospital Charge Code	39900240
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	$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	$17.16
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.19
Rate for Payer: Wellcare Medicare Advantage	$17.16

HEPATITIS DELTA ANTIBODY

Facility

$137.00

Service Code	HCPCS 86692
Hospital Charge Code	38472362
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	$17.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
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

HEPATITIS DELTA ANTIBODY

Facility

$137.00

Service Code	HCPCS 86692
Hospital Charge Code	38472362
Hospital Revenue Code	302
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

HEPATITIS D VIRUS IGM AB EIA

Facility

$390.00

Service Code	HCPCS 86692
Hospital Charge Code	401086692
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

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