Heights University Hospital

All Charges

Charge

Type

Setting

Price

INFLOW & OUTFLOW TUBING

Facility

$6,250.00

Hospital Charge Code	270662954
Hospital Revenue Code	270
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

INFLOW TUBING

Facility

$630.00

Hospital Charge Code	270666124
Hospital Revenue Code	270
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$189.00
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.90
Rate for Payer: Oxford Commercial	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Commercial	$315.00

INFLOW TUBING

Facility

$630.00

Hospital Charge Code	270666124
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

INFLU A AND B RNA PCR

Facility

$584.80

Service Code	HCPCS 87502
Hospital Charge Code	39900297
Hospital Revenue Code	306
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$351.01
Rate for Payer: Aetna Commercial	$310.39
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.01
Rate for Payer: Cigna Commercial	$95.80
Rate for Payer: Cigna Medicare Advantage	$47.90
Rate for Payer: Clover Medicare Advantage	$91.01
Rate for Payer: EmblemHealth Commercial	$287.40
Rate for Payer: Humana Medicare Advantage	$98.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.72
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$101.55
Rate for Payer: Wellcare Medicare Advantage	$95.80

INFLU A AND B RNA PCR

Facility

$584.80

Service Code	HCPCS 87502
Hospital Charge Code	39900297
Hospital Revenue Code	306
Min. Negotiated Rate	$87.72
Max. Negotiated Rate	$87.72
Rate for Payer: Qualcare PPO/HMO/WC	$87.72

INFLUENZA A ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314A
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

INFLUENZA A ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.90
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.65
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: Cigna Medicare Advantage	$6.78
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
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	$13.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.36
Rate for Payer: Wellcare Medicare Advantage	$13.55

INFLUENZA A/B/RSV RNA QL RTPCR

Facility

$791.90

Service Code	HCPCS 87631
Hospital Charge Code	401391989
Hospital Revenue Code	306
Min. Negotiated Rate	$71.31
Max. Negotiated Rate	$522.60
Rate for Payer: Aetna Commercial	$462.12
Rate for Payer: Aetna Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$316.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.60
Rate for Payer: Cigna Commercial	$142.63
Rate for Payer: Cigna Medicare Advantage	$71.31
Rate for Payer: Clover Medicare Advantage	$135.50
Rate for Payer: EmblemHealth Commercial	$427.89
Rate for Payer: Humana Medicare Advantage	$146.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.78
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$142.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$151.19
Rate for Payer: Wellcare Medicare Advantage	$142.63

INFLUENZA A/B/RSV RNA QL RTPCR

Facility

$791.90

Service Code	HCPCS 87631
Hospital Charge Code	401391989
Hospital Revenue Code	306
Min. Negotiated Rate	$118.78
Max. Negotiated Rate	$118.78
Rate for Payer: Qualcare PPO/HMO/WC	$118.78

INFLUENZA AB,TYPE A & B I

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INFLUENZA AB,TYPE A & B I

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041A
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

INFLUENZA AB,TYPE A & B II

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INFLUENZA AB,TYPE A & B II

Facility

$390.00

Service Code	HCPCS 8671091
Hospital Charge Code	39990041B
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

INFLUENZA ADLT INJ 00-01 0.5ML

Facility

$46.75

Service Code	HCPCS 90658
Hospital Charge Code	60629088
Hospital Revenue Code	636
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$14.03
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

INFLUENZA ADLT INJ 00-01 0.5ML

Facility

$46.75

Service Code	HCPCS 90658
Hospital Charge Code	60629088
Hospital Revenue Code	636
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$11.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

INFLUENZA ADULT VACC 0.5ML INJ

Facility

$90.90

Service Code	HCPCS 90658
Hospital Charge Code	60629089
Hospital Revenue Code	636
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$27.27
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

INFLUENZA ADULT VACC 0.5ML INJ

Facility

$90.90

Service Code	HCPCS 90658
Hospital Charge Code	60629089
Hospital Revenue Code	636
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

INFLUENZA ANTIGENT

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38476205
Hospital Revenue Code	302
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.90
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.65
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: Cigna Medicare Advantage	$6.78
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.36
Rate for Payer: Wellcare Medicare Advantage	$13.55

INFLUENZA ANTIGENT

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38476205
Hospital Revenue Code	302
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

INFLUENZA B

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38479063
Hospital Revenue Code	302
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

INFLUENZA B

Facility

$142.00

Service Code	HCPCS 86710
Hospital Charge Code	38479063
Hospital Revenue Code	302
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.90
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.65
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: Cigna Medicare Advantage	$6.78
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.36
Rate for Payer: Wellcare Medicare Advantage	$13.55

INFLUENZA B ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314B
Hospital Revenue Code	302
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$43.90
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.65
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: Cigna Medicare Advantage	$6.78
Rate for Payer: Clover Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$40.65
Rate for Payer: Humana Medicare Advantage	$13.96
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	$13.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.36
Rate for Payer: Wellcare Medicare Advantage	$13.55

INFLUENZA B ANTIBODY

Facility

$52.00

Service Code	HCPCS 86710
Hospital Charge Code	3004314B
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

INFLUENZA INJ TRIVALENT A&B

Facility

$35.00

Service Code	HCPCS 90658
Hospital Charge Code	60629160
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$78.20
Rate for Payer: Aetna Commercial	$10.50
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$22.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

INFLUENZA INJ TRIVALENT A&B

Facility

$35.00

Service Code	HCPCS 90658
Hospital Charge Code	60629160
Hospital Revenue Code	636
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

Know your out-of-pocket cost for care.

All Charges