Heights University Hospital

All Charges

Charge

Type

Setting

Price

MYCOBACTERIA CULT,CSF II

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	39990153B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,CSF III

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39990153C
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
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	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

MYCOBACTERIA CULT,CSF III

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39990153C
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,GASTRIC I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	39990152A
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.88
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

MYCOBACTERIA CULT,GASTRIC I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	39990152A
Hospital Revenue Code	309
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$6.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.88

MYCOBACTERIA CULT,GASTRIC II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	39990152B
Hospital Revenue Code	309
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

MYCOBACTERIA CULT,GASTRIC II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	39990152B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.99
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.57
Rate for Payer: Cigna Commercial	$10.80
Rate for Payer: Cigna Medicare Advantage	$5.40
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.45
Rate for Payer: Wellcare Medicare Advantage	$10.80

MYCOBACTERIA CULT,GASTRIC III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990152C
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

MYCOBACTERIA CULT,GASTRIC III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990152C
Hospital Revenue Code	309
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

MYCOBACTERIA CULT + STAIN I

Facility

$667.59

Service Code	HCPCS 87015
Hospital Charge Code	39990151A
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$6.68
Rate for Payer: Cigna Medicare Advantage	$3.34
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
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	$6.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.08
Rate for Payer: Wellcare Medicare Advantage	$6.68

MYCOBACTERIA CULT + STAIN I

Facility

$667.59

Service Code	HCPCS 87015
Hospital Charge Code	39990151A
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULT + STAIN II

Facility

$667.59

Service Code	HCPCS 87116
Hospital Charge Code	39990151B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.99
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.57
Rate for Payer: Cigna Commercial	$10.80
Rate for Payer: Cigna Medicare Advantage	$5.40
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
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	$10.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.45
Rate for Payer: Wellcare Medicare Advantage	$10.80

MYCOBACTERIA CULT + STAIN II

Facility

$667.59

Service Code	HCPCS 87116
Hospital Charge Code	39990151B
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULT + STAIN III

Facility

$667.59

Service Code	HCPCS 87206
Hospital Charge Code	39990151C
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
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	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

MYCOBACTERIA CULT + STAIN III

Facility

$667.59

Service Code	HCPCS 87206
Hospital Charge Code	39990151C
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULTURE

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	401087116
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULTURE

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	401087116
Hospital Revenue Code	306
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.99
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.57
Rate for Payer: Cigna Commercial	$10.80
Rate for Payer: Cigna Medicare Advantage	$5.40
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
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	$10.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.45
Rate for Payer: Wellcare Medicare Advantage	$10.80

MYCOBACTERIA ID

Facility

$235.00

Service Code	HCPCS 87118
Hospital Charge Code	38475101
Hospital Revenue Code	309
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$14.61
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Aetna Commercial	$47.34
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.53
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.49
Rate for Payer: Wellcare Medicare Advantage	$14.61

MYCOBACTERIA ID

Facility

$235.00

Service Code	HCPCS 87118
Hospital Charge Code	38475101
Hospital Revenue Code	309
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

MYCOBACTERIA,PCR,RESP

Facility

$390.00

Service Code	HCPCS 87556
Hospital Charge Code	39900500
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA,PCR,RESP

Facility

$390.00

Service Code	HCPCS 87556
Hospital Charge Code	39900500
Hospital Revenue Code	306
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$152.72
Rate for Payer: Aetna Commercial	$135.04
Rate for Payer: Aetna Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.72
Rate for Payer: Cigna Commercial	$41.68
Rate for Payer: Cigna Medicare Advantage	$20.84
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
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	$41.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.18
Rate for Payer: Wellcare Medicare Advantage	$41.68

MYCOBACTERIA,PCR,SPUTUM

Facility

$241.20

Service Code	HCPCS 87556
Hospital Charge Code	39900301
Hospital Revenue Code	306
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$152.72
Rate for Payer: Aetna Commercial	$135.04
Rate for Payer: Aetna Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.72
Rate for Payer: Cigna Commercial	$41.68
Rate for Payer: Cigna Medicare Advantage	$20.84
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.18
Rate for Payer: Wellcare Medicare Advantage	$41.68

MYCOBACTERIA,PCR,SPUTUM

Facility

$241.20

Service Code	HCPCS 87556
Hospital Charge Code	39900301
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

MYCOBACTERIA TB PCR

Facility

$241.20

Service Code	HCPCS 87556
Hospital Charge Code	39900499
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

MYCOBACTERIA TB PCR

Facility

$241.20

Service Code	HCPCS 87556
Hospital Charge Code	39900499
Hospital Revenue Code	306
Min. Negotiated Rate	$20.84
Max. Negotiated Rate	$152.72
Rate for Payer: Aetna Commercial	$135.04
Rate for Payer: Aetna Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.72
Rate for Payer: Cigna Commercial	$41.68
Rate for Payer: Cigna Medicare Advantage	$20.84
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.68
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.18
Rate for Payer: Wellcare Medicare Advantage	$41.68

Know your out-of-pocket cost for care.

All Charges