Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEGIONELLA IGG,IGM 1-6, XI

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044K
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, XI

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044K
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

LEGIONELLA IGG,IGM 1-6, XII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044L
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, XII

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044L
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

LEGIONELLA PNEUMOPHILA ABS

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3004793
Hospital Revenue Code	302
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

LEGIONELLA PNEUMOPHILA ABS

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3004793
Hospital Revenue Code	302
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
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	$56.06
Rate for Payer: Cigna Commercial	$15.30
Rate for Payer: Cigna Medicare Advantage	$7.65
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.22
Rate for Payer: Wellcare Medicare Advantage	$15.30

LEGIONELLA PNEUMOPHILA AG

Facility

$75.65

Service Code	HCPCS 87278
Hospital Charge Code	39900281
Hospital Revenue Code	309
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

LEGIONELLA PNEUMOPHILA AG

Facility

$75.65

Service Code	HCPCS 87278
Hospital Charge Code	39900281
Hospital Revenue Code	309
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$50.54
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.16
Rate for Payer: Cigna Commercial	$15.60
Rate for Payer: Cigna Medicare Advantage	$7.80
Rate for Payer: Clover Medicare Advantage	$14.82
Rate for Payer: EmblemHealth Commercial	$46.80
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.54
Rate for Payer: Wellcare Medicare Advantage	$15.60

LEGIONELLA PNEUMOPHLIA AB

Facility

$105.20

Service Code	HCPCS 86713
Hospital Charge Code	39900248
Hospital Revenue Code	302
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$15.78
Rate for Payer: Qualcare PPO/HMO/WC	$15.78

LEGIONELLA PNEUMOPHLIA AB

Facility

$105.20

Service Code	HCPCS 86713
Hospital Charge Code	39900248
Hospital Revenue Code	302
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
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	$56.06
Rate for Payer: Cigna Commercial	$15.30
Rate for Payer: Cigna Medicare Advantage	$7.65
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.78
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.22
Rate for Payer: Wellcare Medicare Advantage	$15.30

LEGIONELLA SPECIES CULTURE

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	401387081
Hospital Revenue Code	306
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	$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	$6.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.03
Rate for Payer: Wellcare Medicare Advantage	$6.63

LEGIONELLA SPECIES CULTURE

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	401387081
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEG MED-LARGE ********

Facility

$225.00

Hospital Charge Code	8002040
Hospital Revenue Code	279
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$112.50

LEG MED-LARGE ********

Facility

$225.00

Hospital Charge Code	8002040
Hospital Revenue Code	279
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

LEG SCREW T1 10.6 X 88MM

Facility

$3,945.00

Hospital Charge Code	270656526
Hospital Revenue Code	278
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$954.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

LEG SCREW T1 10.6 X 88MM

Facility

$3,945.00

Hospital Charge Code	270656526
Hospital Revenue Code	278
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,183.50
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

LEG SECTION PAD

Facility

$1,109.40

Hospital Charge Code	270656362
Hospital Revenue Code	271
Min. Negotiated Rate	$166.41
Max. Negotiated Rate	$166.41
Rate for Payer: Qualcare PPO/HMO/WC	$166.41

LEG SECTION PAD

Facility

$1,109.40

Hospital Charge Code	270656362
Hospital Revenue Code	271
Min. Negotiated Rate	$144.22
Max. Negotiated Rate	$554.70
Rate for Payer: Aetna Commercial	$332.82
Rate for Payer: Aetna Medicare Advantage	$332.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.90
Rate for Payer: Cigna Commercial	$554.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.22
Rate for Payer: Oxford Commercial	$554.70
Rate for Payer: Qualcare PPO/HMO/WC	$166.41
Rate for Payer: UnitedHealthcare Commercial	$554.70

LEG SM ********

Facility

$168.00

Hospital Charge Code	8002032
Hospital Revenue Code	279
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$84.00

LEG SM ********

Facility

$168.00

Hospital Charge Code	8002032
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

LEG TIBIA-FIBUL,REAMPUTATE

Facility

$8,550.00

Service Code	HCPCS 27886
Hospital Charge Code	16000901
Hospital Revenue Code	360
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$1,282.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

LEG TIBIA-FIBUL,REAMPUTATE

Facility

$8,550.00

Service Code	HCPCS 27886
Hospital Charge Code	16000901
Hospital Revenue Code	360
Min. Negotiated Rate	$1,111.50
Max. Negotiated Rate	$9,851.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,111.50
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LENGTHENER HII MICRO

Facility

$23,714.15

Hospital Charge Code	270688786
Hospital Revenue Code	272
Min. Negotiated Rate	$3,082.84
Max. Negotiated Rate	$11,857.08
Rate for Payer: Aetna Commercial	$7,114.24
Rate for Payer: Aetna Medicare Advantage	$7,114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,047.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,047.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,047.11
Rate for Payer: Cigna Commercial	$11,857.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,082.84
Rate for Payer: Oxford Commercial	$11,857.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,557.12
Rate for Payer: UnitedHealthcare Commercial	$11,857.08

LENGTHENER HII MICRO

Facility

$23,714.15

Hospital Charge Code	270688809
Hospital Revenue Code	272
Min. Negotiated Rate	$3,082.84
Max. Negotiated Rate	$11,857.08
Rate for Payer: Aetna Commercial	$7,114.24
Rate for Payer: Aetna Medicare Advantage	$7,114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,047.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,047.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,047.11
Rate for Payer: Cigna Commercial	$11,857.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,082.84
Rate for Payer: Oxford Commercial	$11,857.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,557.12
Rate for Payer: UnitedHealthcare Commercial	$11,857.08

LENGTHENER HII MICRO

Facility

$23,714.15

Hospital Charge Code	270688809
Hospital Revenue Code	272
Min. Negotiated Rate	$3,557.12
Max. Negotiated Rate	$3,557.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,557.12

Know your out-of-pocket cost for care.

All Charges