Heights University Hospital

All Charges

Charge

Type

Setting

Price

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$114.00
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Aetna Commercial	$58.77
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.46
Rate for Payer: Cigna Commercial	$18.14
Rate for Payer: Cigna Medicare Advantage	$9.07
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
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	$18.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.23

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.77
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.46
Rate for Payer: Cigna Commercial	$18.14
Rate for Payer: Cigna Medicare Advantage	$9.07
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
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	$18.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.23
Rate for Payer: Wellcare Medicare Advantage	$18.14

LIVER FUNCTION ASSESSMENT

Facility

$46.10

Hospital Charge Code	6016315
Hospital Revenue Code	510
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

LIVER FUNCTION ASSESSMENT

Facility

$46.10

Hospital Charge Code	6016315
Hospital Revenue Code	510
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$23.05
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.76
Rate for Payer: Cigna Commercial	$23.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.14
Rate for Payer: Aetna Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.31
Rate for Payer: Cigna Commercial	$14.55
Rate for Payer: Cigna Medicare Advantage	$7.28
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.42
Rate for Payer: Wellcare Medicare Advantage	$14.55

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$143.67
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$116,028.59

Service Code	APR-DRG 0013
Min. Negotiated Rate	$86,622.90
Max. Negotiated Rate	$116,028.59
Rate for Payer: Aetna Better Health Medicaid	$113,753.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$116,028.59
Rate for Payer: Wellpoint Medicaid Managed Care	$86,622.90

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$96,805.42

Service Code	APR-DRG 0012
Min. Negotiated Rate	$73,696.79
Max. Negotiated Rate	$96,805.42
Rate for Payer: Aetna Better Health Medicaid	$94,907.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$96,805.42
Rate for Payer: Wellpoint Medicaid Managed Care	$73,696.79

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$203,918.96

Service Code	APR-DRG 0014
Min. Negotiated Rate	$153,683.70
Max. Negotiated Rate	$203,918.96
Rate for Payer: Aetna Better Health Medicaid	$199,920.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$203,918.96
Rate for Payer: Wellpoint Medicaid Managed Care	$153,683.70

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$86,282.38

Service Code	APR-DRG 0011
Min. Negotiated Rate	$69,601.42
Max. Negotiated Rate	$86,282.38
Rate for Payer: Aetna Better Health Medicaid	$84,590.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$86,282.38
Rate for Payer: Wellpoint Medicaid Managed Care	$69,601.42

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$347,668.85

Service Code	MSDRG 005
Min. Negotiated Rate	$98,512.50
Max. Negotiated Rate	$347,668.85
Rate for Payer: Aetna Commercial	$347,668.85
Rate for Payer: Aetna Medicare Advantage	$112,514.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285,318.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285,318.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103,697.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285,318.45
Rate for Payer: Cigna Medicare Advantage	$103,697.37
Rate for Payer: Clover Medicare Advantage	$98,512.50
Rate for Payer: EmblemHealth Commercial	$311,092.11
Rate for Payer: Humana Medicare Advantage	$106,808.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$103,697.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$109,919.21
Rate for Payer: Wellcare Medicare Advantage	$103,697.37

LIVER TRANSPLANT WITHOUT MCC

Facility

$156,359.10

Service Code	MSDRG 006
Min. Negotiated Rate	$46,364.62
Max. Negotiated Rate	$156,359.10
Rate for Payer: Aetna Commercial	$156,359.10
Rate for Payer: Aetna Medicare Advantage	$50,601.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133,424.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133,424.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$48,804.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133,424.28
Rate for Payer: Cigna Medicare Advantage	$48,804.86
Rate for Payer: Clover Medicare Advantage	$46,364.62
Rate for Payer: EmblemHealth Commercial	$146,414.58
Rate for Payer: Humana Medicare Advantage	$50,269.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$48,804.86
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$51,733.15
Rate for Payer: Wellcare Medicare Advantage	$48,804.86

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$8,850.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	7411211
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	7411211
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	7411213
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	366893291
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	366893291
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	7411213
Hospital Revenue Code	480
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

Know your out-of-pocket cost for care.

All Charges