Heights University Hospital

All Charges

Charge

Type

Setting

Price

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148G
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148G
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148F
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148F
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

SENSOSTRIP LCD TEMP INDICATOR

Facility

$2.53

Hospital Charge Code	270642527
Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Qualcare PPO/HMO/WC	$0.38

SENSOSTRIP LCD TEMP INDICATOR

Facility

$2.53

Hospital Charge Code	270642527
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.65
Rate for Payer: Cigna Commercial	$1.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.33
Rate for Payer: Oxford Commercial	$1.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.38
Rate for Payer: UnitedHealthcare Commercial	$1.26

SEPARATION BY DENSITY RETICS

Facility

$100.00

Service Code	HCPCS 86972
Hospital Charge Code	3100186
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

SEPARATION BY DENSITY RETICS

Facility

$100.00

Service Code	HCPCS 86972
Hospital Charge Code	3100186
Hospital Revenue Code	300
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3032738A
Hospital Revenue Code	301
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3009345A
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3032738A
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3009345A
Hospital Revenue Code	301
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3009069B
Hospital Revenue Code	301
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3004168H
Hospital Revenue Code	301
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3004168H
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

SEPARATION BY GEL ELECTROPHORE

Facility

$204.00

Hospital Charge Code	3009069B
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

Separator 4

Facility

$44,400.00

Hospital Charge Code	270685894N
Hospital Revenue Code	272
Min. Negotiated Rate	$5,772.00
Max. Negotiated Rate	$22,200.00
Rate for Payer: Aetna Commercial	$13,320.00
Rate for Payer: Aetna Medicare Advantage	$13,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,322.00
Rate for Payer: Cigna Commercial	$22,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,772.00
Rate for Payer: Oxford Commercial	$22,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,660.00
Rate for Payer: UnitedHealthcare Commercial	$22,200.00

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,320.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.00
Rate for Payer: Oxford Commercial	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Commercial	$2,200.00

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

Know your out-of-pocket cost for care.

All Charges