Heights University Hospital

All Charges

Charge

Type

Setting

Price

H.PYLORI,IGG

Facility

$1,080.00

Service Code	HCPCS 86677
Hospital Charge Code	38479102
Hospital Revenue Code	302
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

H.PYLORI (IGG,IGA,IGM) I

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) I

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H-PYLORI STOOL

Facility

$101.85

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.59
Rate for Payer: Aetna Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.69
Rate for Payer: Cigna Commercial	$14.38
Rate for Payer: Cigna Medicare Advantage	$7.19
Rate for Payer: Clover Medicare Advantage	$13.66
Rate for Payer: EmblemHealth Commercial	$43.14
Rate for Payer: Humana Medicare Advantage	$14.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.28
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.24
Rate for Payer: Wellcare Medicare Advantage	$14.38

H-PYLORI STOOL

Facility

$101.85

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$15.28
Max. Negotiated Rate	$15.28
Rate for Payer: Qualcare PPO/HMO/WC	$15.28

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.48
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.29
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: Cigna Medicare Advantage	$3.31
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.03
Rate for Payer: Wellcare Medicare Advantage	$6.63

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$68.80
Max. Negotiated Rate	$68.80
Rate for Payer: Qualcare PPO/HMO/WC	$68.80

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$246.81
Rate for Payer: Aetna Commercial	$218.25
Rate for Payer: Aetna Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.81
Rate for Payer: Cigna Commercial	$67.36
Rate for Payer: Cigna Medicare Advantage	$33.68
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
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	$67.36
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$71.40
Rate for Payer: Wellcare Medicare Advantage	$67.36

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$96.84
Max. Negotiated Rate	$4,777.67
Rate for Payer: Aetna Commercial	$4,224.80
Rate for Payer: Aetna Medicare Advantage	$1,303.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,777.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,777.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,303.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,777.67
Rate for Payer: Cigna Commercial	$1,303.95
Rate for Payer: Cigna Medicare Advantage	$651.98
Rate for Payer: Clover Medicare Advantage	$1,238.75
Rate for Payer: EmblemHealth Commercial	$3,911.85
Rate for Payer: Humana Medicare Advantage	$1,343.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,303.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$1,382.19
Rate for Payer: Wellcare Medicare Advantage	$1,303.95

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$96.84
Max. Negotiated Rate	$372.45
Rate for Payer: Aetna Commercial	$223.47
Rate for Payer: Aetna Medicare Advantage	$223.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.95
Rate for Payer: Cigna Commercial	$372.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.84
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$114.00

H REFLEX AMP & LATENCY

Facility

$5,700.00

Hospital Charge Code	9109100
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

H REFLEX AMP & LATENCY

Facility

$5,700.00

Hospital Charge Code	9109100
Hospital Revenue Code	922
Min. Negotiated Rate	$741.00
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

H REFLEX TEST

Facility

$285.65

Service Code	HCPCS 95934
Hospital Charge Code	5500040
Hospital Revenue Code	922
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$1,673.00
Rate for Payer: Aetna Commercial	$85.69
Rate for Payer: Aetna Medicare Advantage	$85.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.84
Rate for Payer: Cigna Commercial	$142.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.13
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.85
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

H REFLEX TEST

Facility

$285.65

Service Code	HCPCS 95934
Hospital Charge Code	5500040
Hospital Revenue Code	922
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$42.85

HS DEVELOP PLAN OF CARE

Facility

$372.00

Service Code	HCPCS 99241
Hospital Charge Code	9400045
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

HS DEVELOP PLAN OF CARE

Facility

$372.00

Service Code	HCPCS 99241
Hospital Charge Code	9400045
Hospital Revenue Code	510
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

HSP DISCH> 30 MIN

Facility

$174.00

Service Code	HCPCS 99239
Hospital Charge Code	87502370
Hospital Revenue Code	510
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$116.14
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$116.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

HSP DISCH> 30 MIN

Facility

$174.00

Service Code	HCPCS 99239
Hospital Charge Code	87502370
Hospital Revenue Code	510
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

Know your out-of-pocket cost for care.

All Charges