Heights University Hospital

All Charges

Charge

Type

Setting

Price

HIP W/WO PELVIS MIN 4V LT

Facility

$5,100.00

Service Code	HCPCS 73503LT
Hospital Charge Code	2011547
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	75190641
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$177.98
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	75190641
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94270268
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94061490
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V RT

Facility

$5,100.00

Service Code	HCPCS 73503RT
Hospital Charge Code	2011549
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	75190643
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$177.98
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V RT

Facility

$5,100.00

Service Code	HCPCS 73503RT
Hospital Charge Code	2011549
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94061490
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$177.98
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94270270
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94270270
Hospital Revenue Code	320
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$177.98
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	75190643
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HISTAMINE

Facility

$390.00

Service Code	HCPCS 83088
Hospital Charge Code	39900458
Hospital Revenue Code	301
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.68
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.20
Rate for Payer: Cigna Commercial	$29.53
Rate for Payer: Cigna Medicare Advantage	$14.77
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
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	$29.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.30
Rate for Payer: Wellcare Medicare Advantage	$29.53

HISTAMINE

Facility

$390.00

Service Code	HCPCS 83088
Hospital Charge Code	39900458
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HISTAMINE

Facility

$534.00

Service Code	HCPCS 83088
Hospital Charge Code	38473078
Hospital Revenue Code	301
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.68
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.20
Rate for Payer: Cigna Commercial	$29.53
Rate for Payer: Cigna Medicare Advantage	$14.77
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.30
Rate for Payer: Wellcare Medicare Advantage	$29.53

HISTAMINE

Facility

$534.00

Service Code	HCPCS 83088
Hospital Charge Code	38473078
Hospital Revenue Code	301
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$80.10
Rate for Payer: Qualcare PPO/HMO/WC	$80.10

HISTAMINE (BLOOD)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007499
Hospital Revenue Code	301
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.68
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.20
Rate for Payer: Cigna Commercial	$29.53
Rate for Payer: Cigna Medicare Advantage	$14.77
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.30
Rate for Payer: Wellcare Medicare Advantage	$29.53

HISTAMINE (BLOOD)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007499
Hospital Revenue Code	301
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

HISTAMINE PHOS INJ 2.75MG/1ML

Facility

$21.15

Hospital Charge Code	6002778
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

HISTAMINE PHOS INJ 2.75MG/1ML

Facility

$21.15

Hospital Charge Code	6002778
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

HISTAMINE RELEASE

Facility

$390.00

Service Code	HCPCS 86343
Hospital Charge Code	39900219
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HISTAMINE RELEASE

Facility

$390.00

Service Code	HCPCS 86343
Hospital Charge Code	39900219
Hospital Revenue Code	302
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$12.46
Rate for Payer: Cigna Medicare Advantage	$6.23
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
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	$12.46
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.21
Rate for Payer: Wellcare Medicare Advantage	$12.46

HISTAMINE (URINE)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007507
Hospital Revenue Code	301
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$95.68
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.20
Rate for Payer: Cigna Commercial	$29.53
Rate for Payer: Cigna Medicare Advantage	$14.77
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.30
Rate for Payer: Wellcare Medicare Advantage	$29.53

HISTAMINE (URINE)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007507
Hospital Revenue Code	301
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

HISTO AB (HISTOPLASMA ANTIBODY

Facility

$144.85

Service Code	HCPCS 86698
Hospital Charge Code	3009537
Hospital Revenue Code	302
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.68
Rate for Payer: Aetna Medicare Advantage	$13.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.53
Rate for Payer: Cigna Commercial	$13.79
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$13.10
Rate for Payer: EmblemHealth Commercial	$41.37
Rate for Payer: Humana Medicare Advantage	$14.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.73
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.79
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.62
Rate for Payer: Wellcare Medicare Advantage	$13.79

Know your out-of-pocket cost for care.

All Charges