Heights University Hospital

All Charges

Charge

Type

Setting

Price

H.GALACTOMANNAN ANTIGEN URINE

Facility

$390.00

Service Code	HCPCS 87385
Hospital Charge Code	3847976
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.GALACTOMANNAN ANTIGEN URINE

Facility

$390.00

Service Code	HCPCS 87385
Hospital Charge Code	3847976
Hospital Revenue Code	306
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
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	$48.55
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
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	$13.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.04
Rate for Payer: Wellcare Medicare Advantage	$13.25

HGB

Facility

$22.45

Service Code	HCPCS 85018
Hospital Charge Code	8200338RS
Hospital Revenue Code	305
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.68
Rate for Payer: Cigna Commercial	$2.37
Rate for Payer: Cigna Medicare Advantage	$1.19
Rate for Payer: Clover Medicare Advantage	$2.25
Rate for Payer: EmblemHealth Commercial	$7.11
Rate for Payer: Humana Medicare Advantage	$2.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$2.51
Rate for Payer: Wellcare Medicare Advantage	$2.37

HGB

Facility

$22.45

Service Code	HCPCS 85018
Hospital Charge Code	8200338RS
Hospital Revenue Code	305
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

HGB EVAL CHROMATOGRAPH

Facility

$235.00

Service Code	HCPCS 83020
Hospital Charge Code	3001519A
Hospital Revenue Code	301
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.16
Rate for Payer: Cigna Commercial	$12.87
Rate for Payer: Cigna Medicare Advantage	$6.43
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.64
Rate for Payer: Wellcare Medicare Advantage	$12.87

HGB EVAL CHROMATOGRAPH

Facility

$235.00

Service Code	HCPCS 83020
Hospital Charge Code	3001519A
Hospital Revenue Code	301
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

HGE AB (IGG,M), I

Facility

$88.55

Service Code	HCPCS 8660991
Hospital Charge Code	39990034A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.58
Rate for Payer: Cigna Commercial	$44.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.28
Rate for Payer: UnitedHealthcare Commercial	$114.00

HGE AB (IGG,M), I

Facility

$88.55

Service Code	HCPCS 8660991
Hospital Charge Code	39990034A
Hospital Revenue Code	302
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$13.28
Rate for Payer: Qualcare PPO/HMO/WC	$13.28

HGE AB (IGG,M), II

Facility

$88.55

Service Code	HCPCS 8660991
Hospital Charge Code	39990034B
Hospital Revenue Code	302
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$13.28
Rate for Payer: Qualcare PPO/HMO/WC	$13.28

HGE AB (IGG,M), II

Facility

$88.55

Service Code	HCPCS 8660991
Hospital Charge Code	39990034B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna Medicare Advantage	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.58
Rate for Payer: Cigna Commercial	$44.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.28
Rate for Payer: UnitedHealthcare Commercial	$114.00

HGE AB (IGG,M), III

Facility

$69.95

Service Code	HCPCS 8666691
Hospital Charge Code	39990034C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

HGE AB (IGG,M), III

Facility

$69.95

Service Code	HCPCS 8666691
Hospital Charge Code	39990034C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

HGE AB (IGG,M), IV

Facility

$69.95

Service Code	HCPCS 8666691
Hospital Charge Code	39990034D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$114.00

HGE AB (IGG,M), IV

Facility

$69.95

Service Code	HCPCS 8666691
Hospital Charge Code	39990034D
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

H-GENIN CRUSH MIX 5CC

Facility

$9,790.55

Hospital Charge Code	270700316
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.58
Max. Negotiated Rate	$4,895.27
Rate for Payer: Aetna Commercial	$2,937.16
Rate for Payer: Aetna Medicare Advantage	$2,937.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,496.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,496.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,958.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,496.59
Rate for Payer: Cigna Commercial	$4,895.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,369.31
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.58

H-GENIN CRUSH MIX 5CC

Facility

$9,790.55

Hospital Charge Code	270700316
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.58
Max. Negotiated Rate	$2,369.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,958.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,369.31
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.58

HIB-HEMOPHILUS INFLUENZ B

Facility

$66.26

Service Code	HCPCS 90648
Hospital Charge Code	83652611
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$33.13
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.03
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

HIB-HEMOPHILUS INFLUENZ B

Facility

$66.26

Service Code	HCPCS 90648
Hospital Charge Code	83652611
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$16.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.03
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

HIBICLENS 4% LOT

Facility

$25.39

Service Code	NDC 234057504
Hospital Charge Code	60635807
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$7.62
Rate for Payer: Aetna Medicare Advantage	$7.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.47
Rate for Payer: Cigna Commercial	$12.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$12.70
Rate for Payer: Qualcare PPO/HMO/WC	$3.81
Rate for Payer: UnitedHealthcare Commercial	$12.70

HIBICLENS 4% LOT

Facility

$25.39

Service Code	NDC 234057504
Hospital Charge Code	60635807
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.81

HICKMAN CATHETER

Facility

$378.00

Hospital Charge Code	270335412
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

HICKMAN CATHETER

Facility

$378.00

Hospital Charge Code	270335412
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$113.40
Rate for Payer: Aetna Medicare Advantage	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.39
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

HIGH CONT 1 TO 149 PER ML

Facility

$8.00

Hospital Charge Code	2009380
Hospital Revenue Code	255
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

HIGH CONT 1 TO 149 PER ML

Facility

$8.00

Hospital Charge Code	2009380
Hospital Revenue Code	255
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

HIGH CONT 200 TO 249 PRML

Facility

$8.00

Hospital Charge Code	2009385
Hospital Revenue Code	255
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

Know your out-of-pocket cost for care.

All Charges