Heights University Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY VIRUS,NOT SPECIFIED 2

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476271
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$443.55
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$443.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

ANTIBODY VIRUS,NOT SPECIFIED 2

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476271
Hospital Revenue Code	302
Min. Negotiated Rate	$29.55
Max. Negotiated Rate	$29.55
Rate for Payer: Qualcare PPO/HMO/WC	$29.55

ANTI CARDIOLIPIN AB IGG

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3007045
Hospital Revenue Code	302
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.46
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.25
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: Cigna Medicare Advantage	$12.72
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.98
Rate for Payer: Wellcare Medicare Advantage	$25.45

ANTI CARDIOLIPIN AB IGG

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3007045
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

ANTI CARDIOLIPIN AB IGM

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3007046
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

ANTI CARDIOLIPIN AB IGM

Facility

$358.45

Service Code	HCPCS 86147
Hospital Charge Code	3007046
Hospital Revenue Code	302
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.46
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.25
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: Cigna Medicare Advantage	$12.72
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.98
Rate for Payer: Wellcare Medicare Advantage	$25.45

ANTI-CARDIOLIPIN IGG

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900194
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTI-CARDIOLIPIN IGG

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900194
Hospital Revenue Code	302
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: Cigna Medicare Advantage	$12.72
Rate for Payer: Aetna Commercial	$82.46
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.25
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
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	$25.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.98
Rate for Payer: Wellcare Medicare Advantage	$25.45

ANTICENTROMERE B ANTIBODIES

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3038128
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANTICENTROMERE B ANTIBODIES

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3038128
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

ANTI-CYTOPLASMIC ANTIBODY

Facility

$302.00

Service Code	HCPCS 86021
Hospital Charge Code	38476228
Hospital Revenue Code	302
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

ANTI-CYTOPLASMIC ANTIBODY

Facility

$302.00

Service Code	HCPCS 86021
Hospital Charge Code	38476228
Hospital Revenue Code	302
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	38430016
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	38430016
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	39990216
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	39990216
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	3039017
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	3039017
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	38430017
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	39990217
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	39990217
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	38430017
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDIURETIC HORMONE I

Facility

$57.00

Service Code	HCPCS 83930
Hospital Charge Code	3007150A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.42
Rate for Payer: Aetna Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
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	$24.22
Rate for Payer: Cigna Commercial	$6.61
Rate for Payer: Cigna Medicare Advantage	$3.31
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.01
Rate for Payer: Wellcare Medicare Advantage	$6.61

Know your out-of-pocket cost for care.

All Charges