Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS D VIRUS IGM AB EIA

Facility

$268.84

Service Code	HCPCS 86692
Hospital Charge Code	401386692
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	$34.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.33
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 VIRUS IGM AB EIA

Facility

$268.84

Service Code	HCPCS 86692
Hospital Charge Code	401386692
Hospital Revenue Code	302
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$40.33
Rate for Payer: Qualcare PPO/HMO/WC	$40.33

HEPATITIS D VIRUS IGM AB EIA

Facility

$390.00

Service Code	HCPCS 86692
Hospital Charge Code	401086692
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 D VIRUS RNA, Q.L.

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3035155
Hospital Revenue Code	306
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

HEPATITIS D VIRUS RNA, Q.L.

Facility

$260.00

Service Code	HCPCS 87798
Hospital Charge Code	3035155
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	$33.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
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 E AB (IGM)

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900390
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS E AB (IGM)

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900390
Hospital Revenue Code	302
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	$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	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

HEPATITIS E,IGE

Facility

$272.00

Service Code	HCPCS 86790
Hospital Charge Code	38476272
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

HEPATITIS E,IGE

Facility

$272.00

Service Code	HCPCS 86790
Hospital Charge Code	38476272
Hospital Revenue Code	302
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	$35.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
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

HEPATITIS E IGG

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900389
Hospital Revenue Code	302
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	$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	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

HEPATITIS E IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3038124
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HEPATITIS E IGG

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	39900389
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS E IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3038124
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

HEPATITIS E IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3038123
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

HEPATITIS E IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3038123
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HEPATITIS FUNCTION PROFILE

Facility

$30.00

Service Code	HCPCS 80074
Hospital Charge Code	3004842A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$174.52
Rate for Payer: Aetna Commercial	$154.32
Rate for Payer: Aetna Medicare Advantage	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.52
Rate for Payer: Cigna Commercial	$47.63
Rate for Payer: Cigna Medicare Advantage	$23.82
Rate for Payer: Clover Medicare Advantage	$45.25
Rate for Payer: EmblemHealth Commercial	$142.89
Rate for Payer: Humana Medicare Advantage	$49.06
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	$47.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$50.49
Rate for Payer: Wellcare Medicare Advantage	$47.63

HEPATITIS FUNCTION PROFILE

Facility

$1,297.00

Service Code	HCPCS 80074
Hospital Charge Code	3004843A
Hospital Revenue Code	301
Min. Negotiated Rate	$194.55
Max. Negotiated Rate	$194.55
Rate for Payer: Qualcare PPO/HMO/WC	$194.55

HEPATITIS FUNCTION PROFILE

Facility

$580.00

Hospital Charge Code	3004843
Hospital Revenue Code	301
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$174.00
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

HEPATITIS FUNCTION PROFILE

Facility

$30.00

Service Code	HCPCS 80074
Hospital Charge Code	3004842A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

HEPATITIS FUNCTION PROFILE

Facility

$1,297.00

Service Code	HCPCS 80074
Hospital Charge Code	3004843A
Hospital Revenue Code	301
Min. Negotiated Rate	$23.82
Max. Negotiated Rate	$194.55
Rate for Payer: Aetna Commercial	$154.32
Rate for Payer: Aetna Medicare Advantage	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.52
Rate for Payer: Cigna Commercial	$47.63
Rate for Payer: Cigna Medicare Advantage	$23.82
Rate for Payer: Clover Medicare Advantage	$45.25
Rate for Payer: EmblemHealth Commercial	$142.89
Rate for Payer: Humana Medicare Advantage	$49.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$50.49
Rate for Payer: Wellcare Medicare Advantage	$47.63

HEPATITIS FUNCTION PROFILE

Facility

$580.00

Hospital Charge Code	3004843
Hospital Revenue Code	301
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

HEPATITIS INJ 10MCG/0.05ML

Facility

$171.79

Service Code	HCPCS 90744
Hospital Charge Code	60628287
Hospital Revenue Code	636
Min. Negotiated Rate	$25.77
Max. Negotiated Rate	$51.54
Rate for Payer: Aetna Commercial	$51.54
Rate for Payer: Aetna Medicare Advantage	$51.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.81
Rate for Payer: Cigna Commercial	$33.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.77

HEPATITIS INJ 10MCG/0.05ML

Facility

$171.79

Service Code	HCPCS 90744
Hospital Charge Code	60628287
Hospital Revenue Code	636
Min. Negotiated Rate	$25.77
Max. Negotiated Rate	$41.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.77

HEPATITIS INJ 20MCG/1ML

Facility

$955.15

Service Code	HCPCS 90371
Hospital Charge Code	60629109
Hospital Revenue Code	636
Min. Negotiated Rate	$143.27
Max. Negotiated Rate	$231.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$143.27

HEPATITIS INJ 20MCG/1ML

Facility

$955.15

Service Code	HCPCS 90371
Hospital Charge Code	60629109
Hospital Revenue Code	636
Min. Negotiated Rate	$143.27
Max. Negotiated Rate	$286.55
Rate for Payer: Aetna Commercial	$286.55
Rate for Payer: Aetna Medicare Advantage	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$143.27

Know your out-of-pocket cost for care.

All Charges