Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL IV SURG PATHOLOGY***

Facility

$22.00

Service Code	HCPCS 8830559
Hospital Charge Code	3005294A
Hospital Revenue Code	312
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL OF CARE-BRIEF

Facility

$224.00

Service Code	HCPCS 99211
Hospital Charge Code	94186090
Hospital Revenue Code	510
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

LEVEL OF CARE-BRIEF

Facility

$224.00

Service Code	HCPCS 99211
Hospital Charge Code	94186090
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna Commercial	$67.20
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.12
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

LEVEL OF CARE-COMPREHNSVE

Facility

$464.00

Service Code	HCPCS 99215
Hospital Charge Code	94186110
Hospital Revenue Code	510
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

LEVEL OF CARE-COMPREHNSVE

Facility

$464.00

Service Code	HCPCS 99215
Hospital Charge Code	94186110
Hospital Revenue Code	510
Min. Negotiated Rate	$60.32
Max. Negotiated Rate	$139.20
Rate for Payer: Aetna Commercial	$139.20
Rate for Payer: Aetna Medicare Advantage	$139.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.32
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.32
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

LEVEL OF CARE-EXTENDED

Facility

$371.00

Service Code	HCPCS 99214
Hospital Charge Code	94186105
Hospital Revenue Code	510
Min. Negotiated Rate	$48.23
Max. Negotiated Rate	$111.30
Rate for Payer: Aetna Commercial	$111.30
Rate for Payer: Aetna Medicare Advantage	$111.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.61
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.23
Rate for Payer: Qualcare PPO/HMO/WC	$55.65

LEVEL OF CARE-EXTENDED

Facility

$371.00

Service Code	HCPCS 99214
Hospital Charge Code	94186105
Hospital Revenue Code	510
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$55.65
Rate for Payer: Qualcare PPO/HMO/WC	$55.65

LEVEL OF CARE-INTERMEDATE

Facility

$303.00

Service Code	HCPCS 99213
Hospital Charge Code	94186100
Hospital Revenue Code	510
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LEVEL OF CARE-INTERMEDATE

Facility

$303.00

Service Code	HCPCS 99213
Hospital Charge Code	94186100
Hospital Revenue Code	510
Min. Negotiated Rate	$39.39
Max. Negotiated Rate	$90.90
Rate for Payer: Aetna Commercial	$90.90
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.39
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LEVEL OF CARE-LIMITED

Facility

$267.00

Service Code	HCPCS 99212
Hospital Charge Code	94186095
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.71
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

LEVEL OF CARE-LIMITED

Facility

$267.00

Service Code	HCPCS 99212
Hospital Charge Code	94186095
Hospital Revenue Code	510
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005311
Hospital Revenue Code	312
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005311
Hospital Revenue Code	312
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005310
Hospital Revenue Code	310
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

LEVEL VI SP GROSS&MICROSCOPIC

Facility

$500.00

Service Code	HCPCS 88309TC
Hospital Charge Code	3005310
Hospital Revenue Code	310
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL VI SP GROSS&MICROSCOPIC*

Facility

$39.00

Service Code	HCPCS 8830959
Hospital Charge Code	3005310A
Hospital Revenue Code	312
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL VI SP GROSS&MICROSCOPIC*

Facility

$39.00

Service Code	HCPCS 8830959
Hospital Charge Code	3005310A
Hospital Revenue Code	312
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

LEVEL V SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005301
Hospital Revenue Code	312
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

LEVEL V SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005301
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL V SP GROSS&MICROSCOPIC

Facility

$1,099.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005300
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

LEVEL V SP GROSS&MICROSCOPIC

Facility

$1,099.00

Service Code	HCPCS 88307TC
Hospital Charge Code	3005300
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$549.50
Rate for Payer: Aetna Commercial	$329.70
Rate for Payer: Aetna Medicare Advantage	$329.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.25
Rate for Payer: Cigna Commercial	$549.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL V SP GROSS&MICROSCOPIC**

Facility

$39.00

Service Code	HCPCS 8830759
Hospital Charge Code	3005300A
Hospital Revenue Code	312
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL V SP GROSS&MICROSCOPIC**

Facility

$39.00

Service Code	HCPCS 8830759
Hospital Charge Code	3005300A
Hospital Revenue Code	312
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

LEVETIRACETAM

Facility

$390.00

Service Code	HCPCS 80177
Hospital Charge Code	39900013
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVETIRACETAM

Facility

$256.00

Service Code	HCPCS 82542
Hospital Charge Code	3003457
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

Know your out-of-pocket cost for care.

All Charges