Heights University Hospital

All Charges

Charge

Type

Setting

Price

HERPES (HSV) CULTURE/TYPING

Facility

$287.25

Service Code	HCPCS 87255
Hospital Charge Code	3009249
Hospital Revenue Code	309
Min. Negotiated Rate	$43.09
Max. Negotiated Rate	$43.09
Rate for Payer: Qualcare PPO/HMO/WC	$43.09

HERPES I & II ABS IGG IGM

Facility

$388.85

Hospital Charge Code	3009254
Hospital Revenue Code	302
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$58.33
Rate for Payer: Qualcare PPO/HMO/WC	$58.33

HERPES I & II ABS IGG IGM

Facility

$388.85

Hospital Charge Code	3009254
Hospital Revenue Code	302
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$194.43
Rate for Payer: Aetna Commercial	$116.66
Rate for Payer: Aetna Medicare Advantage	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.16
Rate for Payer: Cigna Commercial	$194.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.33
Rate for Payer: UnitedHealthcare Commercial	$114.00

HERPES SIMP DIR PROBE

Facility

$248.54

Service Code	HCPCS 87529
Hospital Charge Code	38478111
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	$37.18
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	$32.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
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

HERPES SIMP DIR PROBE

Facility

$248.54

Service Code	HCPCS 87529
Hospital Charge Code	38478111
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

HERPES SIMPLEX CULTURE & TYPIN

Facility

$296.00

Service Code	HCPCS 87252
Hospital Charge Code	38475009
Hospital Revenue Code	309
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$84.47
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.52
Rate for Payer: Cigna Commercial	$26.07
Rate for Payer: Cigna Medicare Advantage	$13.04
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.63
Rate for Payer: Wellcare Medicare Advantage	$26.07

HERPES SIMPLEX CULTURE & TYPIN

Facility

$296.00

Service Code	HCPCS 87252
Hospital Charge Code	38475009
Hospital Revenue Code	309
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

HERPES SIMPLEX (HSV) I/II IGG

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3009253
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HERPES SIMPLEX (HSV) I/II IGG

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3009253
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

HERPES SIMPLEX I AB

Facility

$231.25

Service Code	HCPCS 86695
Hospital Charge Code	3009255
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

HERPES SIMPLEX I AB

Facility

$231.25

Service Code	HCPCS 86695
Hospital Charge Code	3009255
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HERPES SIMPLEX II AB

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3009248
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HERPES SIMPLEX II AB

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3009248
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

HERPES SIMPLEX NES ANTBDY

Facility

$390.00

Service Code	HCPCS 86694
Hospital Charge Code	401386694
Hospital Revenue Code	306
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
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	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

HERPES SIMPLEX NES ANTBDY

Facility

$390.00

Service Code	HCPCS 86694
Hospital Charge Code	401386694
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HERPES SIMPLEX TYPE 1 TEST

Facility

$65.95

Service Code	HCPCS 86695
Hospital Charge Code	401386695C
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

HERPES SIMPLEX TYPE 1 TEST

Facility

$65.95

Service Code	HCPCS 86695
Hospital Charge Code	401386695C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.89

HERPES SIMPLEX TYPE 2 TEST

Facility

$96.75

Service Code	HCPCS 86696
Hospital Charge Code	401386696C
Hospital Revenue Code	302
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$14.51

HERPES SIMPLEX TYPE 2 TEST

Facility

$96.75

Service Code	HCPCS 86696
Hospital Charge Code	401386696C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$62.69
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.90
Rate for Payer: Cigna Commercial	$19.35
Rate for Payer: Cigna Medicare Advantage	$9.68
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.51
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.51
Rate for Payer: Wellcare Medicare Advantage	$19.35

HERPES SIMPLEX VIRUS CULT

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900498
Hospital Revenue Code	309
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$124.06
Rate for Payer: Aetna Commercial	$109.71
Rate for Payer: Aetna Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.06
Rate for Payer: Cigna Commercial	$33.86
Rate for Payer: Cigna Medicare Advantage	$16.93
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
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	$33.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$35.89
Rate for Payer: Wellcare Medicare Advantage	$33.86

HERPES SIMPLEX VIRUS CULT

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900498
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HERPES SIMPLEX VIRUS, DFA

Facility

$183.25

Service Code	HCPCS 87299
Hospital Charge Code	3035145
Hospital Revenue Code	309
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$27.49
Rate for Payer: Qualcare PPO/HMO/WC	$27.49

HERPES SIMPLEX VIRUS, DFA

Facility

$183.25

Service Code	HCPCS 87299
Hospital Charge Code	3035145
Hospital Revenue Code	309
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.16
Rate for Payer: Aetna Medicare Advantage	$16.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.10
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	$58.99
Rate for Payer: Cigna Commercial	$16.10
Rate for Payer: Cigna Medicare Advantage	$8.05
Rate for Payer: Clover Medicare Advantage	$15.29
Rate for Payer: EmblemHealth Commercial	$48.30
Rate for Payer: Humana Medicare Advantage	$16.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.10
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.07
Rate for Payer: Wellcare Medicare Advantage	$16.10

HERPES SIMPLEX VIRUS TYPING

Facility

$231.25

Hospital Charge Code	3009250
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HERPES SIMPLEX VIRUS TYPING

Facility

$231.25

Hospital Charge Code	3009250
Hospital Revenue Code	302
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$115.62
Rate for Payer: Aetna Commercial	$69.38
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
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

Know your out-of-pocket cost for care.

All Charges