Heights University Hospital

All Charges

Charge

Type

Setting

Price

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999B
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	$45.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
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

HSV CSF

Facility

$352.35

Service Code	HCPCS 87529
Hospital Charge Code	3035999B
Hospital Revenue Code	306
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

HSV CSF

Facility

$128.57

Service Code	HCPCS 87529
Hospital Charge Code	3035999A
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: Oxford Commercial	$101.00
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

HSV CULTURE

Facility

$220.85

Service Code	HCPCS 87253
Hospital Charge Code	3009251
Hospital Revenue Code	309
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$65.45
Rate for Payer: Aetna Medicare Advantage	$20.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.20
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	$74.01
Rate for Payer: Cigna Commercial	$20.20
Rate for Payer: Cigna Medicare Advantage	$10.10
Rate for Payer: Clover Medicare Advantage	$19.19
Rate for Payer: EmblemHealth Commercial	$60.60
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21.41
Rate for Payer: Wellcare Medicare Advantage	$20.20

HSV CULTURE

Facility

$220.85

Service Code	HCPCS 87253
Hospital Charge Code	3009251
Hospital Revenue Code	309
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

HSV CULTURE WITHOUT TYPING

Facility

$325.00

Service Code	HCPCS 87255
Hospital Charge Code	3038073
Hospital Revenue Code	309
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$124.06
Rate for Payer: Aetna Commercial	$109.71
Rate for Payer: Aetna Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.06
Rate for Payer: Cigna Commercial	$33.86
Rate for Payer: Cigna Medicare Advantage	$16.93
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$35.89
Rate for Payer: Wellcare Medicare Advantage	$33.86

HSV CULTURE WITHOUT TYPING

Facility

$325.00

Service Code	HCPCS 87255
Hospital Charge Code	3038073
Hospital Revenue Code	309
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

HSV CULTURE,W/REFL TO TYP

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900497
Hospital Revenue Code	309
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$124.06
Rate for Payer: Aetna Commercial	$109.71
Rate for Payer: Aetna Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.06
Rate for Payer: Cigna Commercial	$33.86
Rate for Payer: Cigna Medicare Advantage	$16.93
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
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	$33.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$35.89
Rate for Payer: Wellcare Medicare Advantage	$33.86

HSV CULTURE,W/REFL TO TYP

Facility

$390.00

Service Code	HCPCS 87255
Hospital Charge Code	39900497
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650A
Hospital Revenue Code	302
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.61
Rate for Payer: Aetna Medicare Advantage	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.37
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650A
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083A
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

HSV I/2 IGG/IGM CSF I

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083A
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650B
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083B
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 8669491
Hospital Charge Code	3000650B
Hospital Revenue Code	302
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.61
Rate for Payer: Aetna Medicare Advantage	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.37
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

HSV I/2 IGG/IGM CSF II

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3038083B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

HSV TYPE 2

Facility

$38.35

Service Code	HCPCS 87140
Hospital Charge Code	39900271
Hospital Revenue Code	309
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.75

HSV TYPE 2

Facility

$38.35

Service Code	HCPCS 87140
Hospital Charge Code	39900271
Hospital Revenue Code	309
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.41
Rate for Payer: Cigna Commercial	$5.57
Rate for Payer: Cigna Medicare Advantage	$2.79
Rate for Payer: Clover Medicare Advantage	$5.29
Rate for Payer: EmblemHealth Commercial	$16.71
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.57
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.90
Rate for Payer: Wellcare Medicare Advantage	$5.57

HSV TYPE I/II DNA BY PCR

Facility

$232.00

Service Code	HCPCS 87801
Hospital Charge Code	3035032
Hospital Revenue Code	306
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$34.80

HSV TYPE I/II DNA BY PCR

Facility

$232.00

Service Code	HCPCS 87801
Hospital Charge Code	3035032
Hospital Revenue Code	306
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$257.21
Rate for Payer: Aetna Commercial	$227.45
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.21
Rate for Payer: Cigna Commercial	$70.20
Rate for Payer: Cigna Medicare Advantage	$35.10
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$74.41
Rate for Payer: Wellcare Medicare Advantage	$70.20

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254
Hospital Revenue Code	309
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.37
Rate for Payer: Aetna Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.67
Rate for Payer: Cigna Commercial	$19.56
Rate for Payer: Cigna Medicare Advantage	$9.78
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
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	$19.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.73
Rate for Payer: Wellcare Medicare Advantage	$19.56

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254A
Hospital Revenue Code	309
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.37
Rate for Payer: Aetna Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.67
Rate for Payer: Cigna Commercial	$19.56
Rate for Payer: Cigna Medicare Advantage	$9.78
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
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	$19.56
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.73
Rate for Payer: Wellcare Medicare Advantage	$19.56

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV/VZV

Facility

$390.00

Service Code	HCPCS 87254
Hospital Charge Code	401387254A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges