Heights University Hospital

All Charges

Charge

Type

Setting

Price

MS PROFILE I

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3037060A
Hospital Revenue Code	307
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$83.59
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.53
Rate for Payer: Cigna Commercial	$25.80
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.35
Rate for Payer: Wellcare Medicare Advantage	$25.80

MS PROFILE II

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3037060B
Hospital Revenue Code	307
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.21
Rate for Payer: Aetna Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.51
Rate for Payer: Cigna Commercial	$7.78
Rate for Payer: Cigna Medicare Advantage	$3.89
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.25
Rate for Payer: Wellcare Medicare Advantage	$7.78

MS PROFILE II

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3037060B
Hospital Revenue Code	307
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

MS PROFILE III

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060C
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

MS PROFILE III

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060C
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

MS PROFILE IV

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060D
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

MS PROFILE IV

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060D
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

MS PROFILE V

Facility

$181.65

Service Code	HCPCS 83916
Hospital Charge Code	3037060E
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

MS PROFILE V

Facility

$181.65

Service Code	HCPCS 83916
Hospital Charge Code	3037060E
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

MSTA/1EACH

Facility

$18.00

Hospital Charge Code	60633461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

MSTA/1EACH

Facility

$18.00

Hospital Charge Code	60633461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$217.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

MTHFR

Facility

$300.00

Service Code	HCPCS 81291
Hospital Charge Code	3037000
Hospital Revenue Code	310
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$239.41
Rate for Payer: Aetna Commercial	$211.70
Rate for Payer: Aetna Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.41
Rate for Payer: Cigna Commercial	$65.34
Rate for Payer: Cigna Medicare Advantage	$32.67
Rate for Payer: Clover Medicare Advantage	$62.07
Rate for Payer: EmblemHealth Commercial	$196.02
Rate for Payer: Humana Medicare Advantage	$67.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$69.26
Rate for Payer: Wellcare Medicare Advantage	$65.34

MTHFR

Facility

$300.00

Service Code	HCPCS 81291
Hospital Charge Code	3037000
Hospital Revenue Code	310
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$239.41
Rate for Payer: Aetna Commercial	$211.70
Rate for Payer: Aetna Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.41
Rate for Payer: Cigna Commercial	$65.34
Rate for Payer: Cigna Medicare Advantage	$32.67
Rate for Payer: Clover Medicare Advantage	$62.07
Rate for Payer: EmblemHealth Commercial	$196.02
Rate for Payer: Humana Medicare Advantage	$67.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.41
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$69.26
Rate for Payer: Wellcare Medicare Advantage	$65.34

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$58.41
Max. Negotiated Rate	$58.41
Rate for Payer: Qualcare PPO/HMO/WC	$58.41

MTMS BY PHARM EST 15 MIN

Facility

$260.00

Service Code	HCPCS 99605
Hospital Charge Code	6063943374
Hospital Revenue Code	250
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$130.00

MTMS BY PHARM EST 15 MIN

Facility

$260.00

Service Code	HCPCS 99605
Hospital Charge Code	6063943374
Hospital Revenue Code	250
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$854.61
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$1,972.18
Rate for Payer: Aetna Medicare Advantage	$1,972.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,676.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,676.36
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	$1,676.36
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.61
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$986.09
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$986.09
Max. Negotiated Rate	$986.09
Rate for Payer: Qualcare PPO/HMO/WC	$986.09

MTP CE ARTICULAR 15X2.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270693567
Hospital Revenue Code	278
Min. Negotiated Rate	$257.13
Max. Negotiated Rate	$4,509.00
Rate for Payer: Aetna Commercial	$4,509.00
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$428.55
Rate for Payer: Cigna Medicare Advantage	$257.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

MTP CE ARTICULAR 15X2.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270693567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

Know your out-of-pocket cost for care.

All Charges