Heights University Hospital

All Charges

Charge

Type

Setting

Price

RUBELLA IMMUNITY

Facility

$478.00

Service Code	HCPCS 86762
Hospital Charge Code	38476030
Hospital Revenue Code	302
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$71.70

RUBELLA IMMUNITY

Facility

$478.00

Service Code	HCPCS 86762
Hospital Charge Code	38476030
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

RUBELLA SCREEN

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3009553
Hospital Revenue Code	302
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

RUBELLA SCREEN

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3009553
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

RUBELLA SCREENING***

Facility

$54.00

Service Code	HCPCS 86762
Hospital Charge Code	3004041
Hospital Revenue Code	309
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

RUBELLA SCREENING***

Facility

$54.00

Service Code	HCPCS 86762
Hospital Charge Code	3004041
Hospital Revenue Code	309
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

RUBELLA VIRUS VACCINE INJ

Facility

$152.96

Service Code	NDC 6467300
Hospital Charge Code	60628310
Hospital Revenue Code	251
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$22.94
Rate for Payer: Qualcare PPO/HMO/WC	$22.94

RUBELLA VIRUS VACCINE INJ

Facility

$152.96

Service Code	NDC 6467300
Hospital Charge Code	60628310
Hospital Revenue Code	251
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$76.48
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$45.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.00
Rate for Payer: Cigna Commercial	$76.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.88
Rate for Payer: Oxford Commercial	$76.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.94
Rate for Payer: UnitedHealthcare Commercial	$76.48

RUBELLA VIR VACC INJ .5ML

Facility

$125.45

Hospital Charge Code	6004824
Hospital Revenue Code	250
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$62.73
Rate for Payer: Aetna Commercial	$37.63
Rate for Payer: Aetna Medicare Advantage	$37.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.99
Rate for Payer: Cigna Commercial	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.31
Rate for Payer: Oxford Commercial	$62.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$62.73

RUBELLA VIR VACC INJ .5ML

Facility

$125.45

Hospital Charge Code	6004824
Hospital Revenue Code	250
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

RUBEOLA AB, CF

Facility

$302.00

Service Code	HCPCS 86765
Hospital Charge Code	38476038
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

RUBEOLA AB, CF

Facility

$302.00

Service Code	HCPCS 86765
Hospital Charge Code	38476038
Hospital Revenue Code	302
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

RUBEOLA AB, IGG

Facility

$119.25

Service Code	HCPCS 86765
Hospital Charge Code	3009719
Hospital Revenue Code	302
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

RUBEOLA AB, IGG

Facility

$119.25

Service Code	HCPCS 86765
Hospital Charge Code	3009719
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

RUBEOLA AB (IGG),EIA

Facility

$66.50

Service Code	HCPCS 86765
Hospital Charge Code	39900253
Hospital Revenue Code	302
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

RUBEOLA AB (IGG),EIA

Facility

$66.50

Service Code	HCPCS 86765
Hospital Charge Code	39900253
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

RUBEOLA AB, IGM

Facility

$119.25

Service Code	HCPCS 86765
Hospital Charge Code	3004371
Hospital Revenue Code	302
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

RUBEOLA AB, IGM

Facility

$119.25

Service Code	HCPCS 86765
Hospital Charge Code	3004371
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

RUBEOLA ANTIBODIES, IGM

Facility

$311.00

Service Code	HCPCS 86765
Hospital Charge Code	38476140
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

RUBEOLA ANTIBODIES, IGM

Facility

$311.00

Service Code	HCPCS 86765
Hospital Charge Code	38476140
Hospital Revenue Code	302
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

RUBEOLA IGG

Facility

$465.00

Service Code	HCPCS 86765
Hospital Charge Code	38476037
Hospital Revenue Code	302
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

RUBEOLA IGG

Facility

$465.00

Service Code	HCPCS 86765
Hospital Charge Code	38476037
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
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	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

Ruby Coil 36mmx60cm

Facility

$6,450.00

Hospital Charge Code	270687055
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$1,560.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

Ruby Coil 36mmx60cm

Facility

$6,450.00

Hospital Charge Code	270687055
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

Ruby Coil 40mmx60cm

Facility

$6,450.00

Hospital Charge Code	270687054
Hospital Revenue Code	278
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$1,935.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

Know your out-of-pocket cost for care.

All Charges