Heights University Hospital

All Charges

Charge

Type

Setting

Price

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$324.60
Rate for Payer: Qualcare PPO/HMO/WC	$324.60

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$649.20
Rate for Payer: Aetna Commercial	$649.20
Rate for Payer: Aetna Medicare Advantage	$649.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.82
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

P1 E1/15ML

Facility

$71.00

Hospital Charge Code	60634560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

P1 E1/15ML

Facility

$71.00

Hospital Charge Code	60634560
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

P29 ALCOHOL SCREEN W/COC***

Facility

$50.00

Hospital Charge Code	3032695
Hospital Revenue Code	309
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

P29 ALCOHOL SCREEN W/COC***

Facility

$50.00

Hospital Charge Code	3032695
Hospital Revenue Code	309
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

P2 E1/15ML

Facility

$71.00

Hospital Charge Code	60634559
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$21.30
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$35.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$35.50

P2 E1/15ML

Facility

$71.00

Hospital Charge Code	60634559
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.27
Rate for Payer: Cigna Commercial	$24.91
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
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	$24.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.40
Rate for Payer: Wellcare Medicare Advantage	$24.91

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$22.15
Rate for Payer: Qualcare PPO/HMO/WC	$22.15

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.27
Rate for Payer: Cigna Commercial	$24.91
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
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	$24.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.40
Rate for Payer: Wellcare Medicare Advantage	$24.91

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.27
Rate for Payer: Cigna Commercial	$24.91
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.40
Rate for Payer: Wellcare Medicare Advantage	$24.91

P4 E1/15ML

Facility

$61.00

Hospital Charge Code	60634558
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

P4 E1/15ML

Facility

$61.00

Hospital Charge Code	60634558
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$30.50

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

P6 E1/15ML

Facility

$89.00

Hospital Charge Code	60634557
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

P6 E1/15ML

Facility

$89.00

Hospital Charge Code	60634557
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

PACE INTERROGATION W/PROG DUAL

Facility

$500.00

Service Code	HCPCS 93280
Hospital Charge Code	94053065
Hospital Revenue Code	480
Min. Negotiated Rate	$38.15
Max. Negotiated Rate	$1,793.00
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) NJ Health	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PACE INTERROGATION W/PROG DUAL

Facility

$214.68

Service Code	HCPCS 93280
Hospital Charge Code	74115017
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

PACE INTERROGATION W/PROG DUAL

Facility

$214.68

Service Code	HCPCS 93280
Hospital Charge Code	74115017
Hospital Revenue Code	480
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare Advantage	$64.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.74
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PACE INTERROGATION W/PROG DUAL

Facility

$500.00

Service Code	HCPCS 93280
Hospital Charge Code	5100279
Hospital Revenue Code	480
Min. Negotiated Rate	$38.15
Max. Negotiated Rate	$1,793.00
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) NJ Health	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

PACE INTERROGATION W/PROG DUAL

Facility

$214.68

Service Code	HCPCS 93280
Hospital Charge Code	74116017
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

Know your out-of-pocket cost for care.

All Charges