Heights University Hospital

All Charges

Charge

Type

Setting

Price

HOUSE DUST GREER, IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035144
Hospital Revenue Code	305
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.91
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
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	$19.13
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: Cigna Medicare Advantage	$2.61
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.53
Rate for Payer: Wellcare Medicare Advantage	$5.22

HOUSE DUST GREER, IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035144
Hospital Revenue Code	305
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

HOUSING STANDARD

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705428
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

HOUSING STANDARD

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705428
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

HOVERMAT SG PT USE 34 HM345SPU

Facility

$517.28

Hospital Charge Code	270641062
Hospital Revenue Code	272
Min. Negotiated Rate	$67.25
Max. Negotiated Rate	$258.64
Rate for Payer: Aetna Commercial	$155.18
Rate for Payer: Aetna Medicare Advantage	$155.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.91
Rate for Payer: Cigna Commercial	$258.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.25
Rate for Payer: Oxford Commercial	$258.64
Rate for Payer: Qualcare PPO/HMO/WC	$77.59
Rate for Payer: UnitedHealthcare Commercial	$258.64

HOVERMAT SG PT USE 34 HM345SPU

Facility

$517.28

Hospital Charge Code	270641062
Hospital Revenue Code	272
Min. Negotiated Rate	$77.59
Max. Negotiated Rate	$77.59
Rate for Payer: Qualcare PPO/HMO/WC	$77.59

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$33.74
Rate for Payer: Qualcare PPO/HMO/WC	$33.74

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$112.47
Rate for Payer: Aetna Commercial	$67.48
Rate for Payer: Aetna Medicare Advantage	$67.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.36
Rate for Payer: Cigna Commercial	$112.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.24
Rate for Payer: Oxford Commercial	$112.47
Rate for Payer: Qualcare PPO/HMO/WC	$33.74
Rate for Payer: UnitedHealthcare Commercial	$112.47

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$35.62
Rate for Payer: Qualcare PPO/HMO/WC	$35.62

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$30.88
Max. Negotiated Rate	$118.75
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.56
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.88
Rate for Payer: Oxford Commercial	$118.75
Rate for Payer: Qualcare PPO/HMO/WC	$35.62
Rate for Payer: UnitedHealthcare Commercial	$118.75

H & P COMPREHENSIVE LEV 4****

Facility

$81.00

Service Code	HCPCS 99204
Hospital Charge Code	9300054
Hospital Revenue Code	519
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$126.45
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

H & P COMPREHENSIVE LEV 4****

Facility

$81.00

Service Code	HCPCS 99204
Hospital Charge Code	9300054
Hospital Revenue Code	519
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$302.20
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$302.20
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
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	$35.72
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	$31.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
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

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV DNA LOW/HIGH RISK II

Facility

$241.20

Service Code	HCPCS 87621
Hospital Charge Code	39990137B
Hospital Revenue Code	306
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$120.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: Aetna Commercial	$72.36
Rate for Payer: Aetna Medicare Advantage	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.51
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$101.00

HPV DNA LOW/HIGH RISK II

Facility

$241.20

Service Code	HCPCS 87621
Hospital Charge Code	39990137B
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV GENOTYPE 16/18 I

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HPV GENOTYPE 16/18 I

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136A
Hospital Revenue Code	306
Min. Negotiated Rate	$20.27
Max. Negotiated Rate	$148.58
Rate for Payer: Aetna Commercial	$131.38
Rate for Payer: Aetna Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.58
Rate for Payer: Cigna Commercial	$40.55
Rate for Payer: Cigna Medicare Advantage	$20.27
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
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	$40.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42.98
Rate for Payer: Wellcare Medicare Advantage	$40.55

HPV GENOTYPE 16/18 II

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HPV GENOTYPE 16/18 II

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136B
Hospital Revenue Code	306
Min. Negotiated Rate	$20.27
Max. Negotiated Rate	$148.58
Rate for Payer: Aetna Commercial	$131.38
Rate for Payer: Aetna Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.58
Rate for Payer: Cigna Commercial	$40.55
Rate for Payer: Cigna Medicare Advantage	$20.27
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
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	$40.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$42.98
Rate for Payer: Wellcare Medicare Advantage	$40.55

HPV HIGH-RISK TYPES

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39990235
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

Know your out-of-pocket cost for care.

All Charges