Heights University Hospital

All Charges

Charge

Type

Setting

Price

HIV-1 VIRT1

Facility

$892.00

Service Code	HCPCS 87900
Hospital Charge Code	3035078A
Hospital Revenue Code	306
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$133.80

HIV-1 VIRT1

Facility

$892.00

Service Code	HCPCS 87900
Hospital Charge Code	3035078A
Hospital Revenue Code	306
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$477.60
Rate for Payer: Aetna Commercial	$422.33
Rate for Payer: Aetna Medicare Advantage	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$477.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$477.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$477.60
Rate for Payer: Cigna Commercial	$130.35
Rate for Payer: Cigna Medicare Advantage	$65.17
Rate for Payer: Clover Medicare Advantage	$123.83
Rate for Payer: EmblemHealth Commercial	$391.05
Rate for Payer: Humana Medicare Advantage	$134.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$130.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$138.17
Rate for Payer: Wellcare Medicare Advantage	$130.35

HIV-1 VIRT2

Facility

$1,587.00

Service Code	HCPCS 87901
Hospital Charge Code	3035078B
Hospital Revenue Code	306
Min. Negotiated Rate	$238.05
Max. Negotiated Rate	$238.05
Rate for Payer: Qualcare PPO/HMO/WC	$238.05

HIV-1 VIRT2

Facility

$1,587.00

Service Code	HCPCS 87901
Hospital Charge Code	3035078B
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	$206.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$238.05
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

HIV-1 VIRTPHENO W/ INTERPRET.

Facility

$1,784.00

Hospital Charge Code	3035078
Hospital Revenue Code	306
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$892.00
Rate for Payer: Aetna Commercial	$535.20
Rate for Payer: Aetna Medicare Advantage	$535.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$454.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$454.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$454.92
Rate for Payer: Cigna Commercial	$892.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

HIV-1 VIRTPHENO W/ INTERPRET.

Facility

$1,784.00

Hospital Charge Code	3035078
Hospital Revenue Code	306
Min. Negotiated Rate	$267.60
Max. Negotiated Rate	$267.60
Rate for Payer: Qualcare PPO/HMO/WC	$267.60

HIV-2 ABS

Facility

$139.25

Service Code	HCPCS 86702
Hospital Charge Code	3032330
Hospital Revenue Code	302
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.80
Rate for Payer: Aetna Medicare Advantage	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.54
Rate for Payer: Cigna Commercial	$13.52
Rate for Payer: Cigna Medicare Advantage	$6.76
Rate for Payer: Clover Medicare Advantage	$12.84
Rate for Payer: EmblemHealth Commercial	$40.56
Rate for Payer: Humana Medicare Advantage	$13.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.33
Rate for Payer: Wellcare Medicare Advantage	$13.52

HIV-2 ABS

Facility

$139.25

Service Code	HCPCS 86702
Hospital Charge Code	3032330
Hospital Revenue Code	302
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

HIV-2 AB,WESTERN BLOT

Facility

$646.00

Service Code	HCPCS 86689
Hospital Charge Code	38476268
Hospital Revenue Code	302
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

HIV-2 AB,WESTERN BLOT

Facility

$646.00

Service Code	HCPCS 86689
Hospital Charge Code	38476268
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	$39.64
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	$83.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
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

HIV2 PROBE REVRSE TRNSCRIPJ

Facility

$437.57

Service Code	HCPCS 87538
Hospital Charge Code	401187538
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	$56.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.64
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

HIV2 PROBE REVRSE TRNSCRIPJ

Facility

$437.57

Service Code	HCPCS 87538
Hospital Charge Code	401187538
Hospital Revenue Code	306
Min. Negotiated Rate	$65.64
Max. Negotiated Rate	$65.64
Rate for Payer: Qualcare PPO/HMO/WC	$65.64

HIV AB W/CONF P24, HTLV

Facility

$246.45

Service Code	HCPCS 86689
Hospital Charge Code	3006657
Hospital Revenue Code	302
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

HIV AB W/CONF P24, HTLV

Facility

$246.45

Service Code	HCPCS 86689
Hospital Charge Code	3006657
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	$39.64
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	$32.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
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

HIVAC 7 SINGLE/DOUBLE CEM INJ

Facility

$1,175.00

Hospital Charge Code	270678234
Hospital Revenue Code	272
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$176.25
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

HIVAC 7 SINGLE/DOUBLE CEM INJ

Facility

$1,175.00

Hospital Charge Code	270678234
Hospital Revenue Code	272
Min. Negotiated Rate	$152.75
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$352.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.75
Rate for Payer: Oxford Commercial	$587.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Commercial	$587.50

HIV DNA BY PCR

Facility

$414.45

Service Code	HCPCS 87535
Hospital Charge Code	3000817
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	$53.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
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

HIV DNA BY PCR

Facility

$414.45

Service Code	HCPCS 87535
Hospital Charge Code	3000817
Hospital Revenue Code	306
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

HIV - ENZYME IMMUNOASSAY

Facility

$1,066.43

Service Code	HCPCS 87390
Hospital Charge Code	3000818
Hospital Revenue Code	306
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$159.96
Rate for Payer: Aetna Commercial	$77.95
Rate for Payer: Aetna Medicare Advantage	$24.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.16
Rate for Payer: Cigna Commercial	$24.06
Rate for Payer: Cigna Medicare Advantage	$12.03
Rate for Payer: Clover Medicare Advantage	$22.86
Rate for Payer: EmblemHealth Commercial	$72.18
Rate for Payer: Humana Medicare Advantage	$24.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.96
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.06
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.50
Rate for Payer: Wellcare Medicare Advantage	$24.06

HIV - ENZYME IMMUNOASSAY

Facility

$1,066.43

Service Code	HCPCS 87390
Hospital Charge Code	3000818
Hospital Revenue Code	306
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$159.96

HIV GENOSURE MG

Facility

$892.00

Service Code	HCPCS 87900
Hospital Charge Code	3038078
Hospital Revenue Code	306
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$133.80

HIV GENOSURE MG

Facility

$892.00

Service Code	HCPCS 87900
Hospital Charge Code	3038078
Hospital Revenue Code	306
Min. Negotiated Rate	$65.17
Max. Negotiated Rate	$477.60
Rate for Payer: Aetna Commercial	$422.33
Rate for Payer: Aetna Medicare Advantage	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$477.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$477.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$477.60
Rate for Payer: Cigna Commercial	$130.35
Rate for Payer: Cigna Medicare Advantage	$65.17
Rate for Payer: Clover Medicare Advantage	$123.83
Rate for Payer: EmblemHealth Commercial	$391.05
Rate for Payer: Humana Medicare Advantage	$134.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$130.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$138.17
Rate for Payer: Wellcare Medicare Advantage	$130.35

HIV GENOTYPE/VIRTUAL PHENOTYPE

Facility

$2,000.00

Service Code	HCPCS 87901
Hospital Charge Code	3032340
Hospital Revenue Code	306
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

HIV GENOTYPE/VIRTUAL PHENOTYPE

Facility

$2,000.00

Service Code	HCPCS 87901
Hospital Charge Code	3032340
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	$260.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
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

HIV GENOTYPING,OTHER

Facility

$911.60

Service Code	HCPCS 87906
Hospital Charge Code	38477210
Hospital Revenue Code	306
Min. Negotiated Rate	$136.74
Max. Negotiated Rate	$136.74
Rate for Payer: Qualcare PPO/HMO/WC	$136.74

Know your out-of-pocket cost for care.

All Charges