Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPECIAL RADIATION TREATMENT-PC

Facility

$556.65

Service Code	HCPCS 7747026
Hospital Charge Code	85000815
Hospital Revenue Code	333
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$83.50

SPECIAL RADIATION TREATMENT-TC

Facility

$419.60

Service Code	HCPCS 77470TC
Hospital Charge Code	85000810
Hospital Revenue Code	333
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$62.94
Rate for Payer: Qualcare PPO/HMO/WC	$62.94

SPECIAL RADIATION TREATMENT-TC

Facility

$419.60

Service Code	HCPCS 77470TC
Hospital Charge Code	85000810
Hospital Revenue Code	333
Min. Negotiated Rate	$54.55
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$125.88
Rate for Payer: Aetna Medicare Advantage	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.00
Rate for Payer: Cigna Commercial	$209.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.55
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.94
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

SPECIAL STAIN I

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	3005238
Hospital Revenue Code	312
Min. Negotiated Rate	$78.96
Max. Negotiated Rate	$78.96
Rate for Payer: Qualcare PPO/HMO/WC	$78.96

SPECIAL STAIN I

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	3005238
Hospital Revenue Code	312
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$157.92
Rate for Payer: Aetna Commercial	$157.92
Rate for Payer: Aetna Medicare Advantage	$157.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.23
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$62.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.96
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIAL STAIN II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005246
Hospital Revenue Code	312
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIAL STAIN II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005246
Hospital Revenue Code	312
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

SPECIAL STAINS - GROUP II

Facility

$459.00

Service Code	HCPCS 88313
Hospital Charge Code	38474064
Hospital Revenue Code	310
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$68.85
Rate for Payer: Qualcare PPO/HMO/WC	$68.85

SPECIAL STAINS - GROUP II

Facility

$459.00

Service Code	HCPCS 88313
Hospital Charge Code	38474064
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna Medicare Advantage	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.05
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIAL STAINS HISTOCHEM/FROZE

Facility

$101.00

Service Code	HCPCS 88314
Hospital Charge Code	38477123
Hospital Revenue Code	312
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

SPECIAL STAINS HISTOCHEM/FROZE

Facility

$101.00

Service Code	HCPCS 88314
Hospital Charge Code	38477123
Hospital Revenue Code	312
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$93.41
Rate for Payer: Cigna Medicare Advantage	$46.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIAL STAINS-MICROBES

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	38474061
Hospital Revenue Code	310
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$157.92
Rate for Payer: Aetna Commercial	$157.92
Rate for Payer: Aetna Medicare Advantage	$157.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.23
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$62.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.96
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPECIAL STAINS-MICROBES

Facility

$526.40

Service Code	HCPCS 88312
Hospital Charge Code	38474061
Hospital Revenue Code	310
Min. Negotiated Rate	$78.96
Max. Negotiated Rate	$78.96
Rate for Payer: Qualcare PPO/HMO/WC	$78.96

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$245.34
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Better Health Medicaid	$417.12
Rate for Payer: Aetna Commercial	$566.17
Rate for Payer: Aetna Medicare Advantage	$566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.24
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.34
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$4,435.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$425.46

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

SPECIAL TELETX PORT PLAN-PC

Facility

$252.60

Service Code	HCPCS 7732126
Hospital Charge Code	85000530
Hospital Revenue Code	333
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$37.89
Rate for Payer: Qualcare PPO/HMO/WC	$37.89

SPECIAL TELETX PORT PLAN-PC

Facility

$252.60

Service Code	HCPCS 7732126
Hospital Charge Code	85000530
Hospital Revenue Code	333
Min. Negotiated Rate	$32.84
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$75.78
Rate for Payer: Aetna Medicare Advantage	$75.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.41
Rate for Payer: Cigna Commercial	$126.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.89
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

SPECIAL TELETX PORT PLAN-TC

Facility

$306.55

Service Code	HCPCS 77321TC
Hospital Charge Code	85000525
Hospital Revenue Code	333
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$45.98

SPECIAL TELETX PORT PLAN-TC

Facility

$306.55

Service Code	HCPCS 77321TC
Hospital Charge Code	85000525
Hospital Revenue Code	333
Min. Negotiated Rate	$39.85
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$91.97
Rate for Payer: Aetna Medicare Advantage	$91.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.17
Rate for Payer: Cigna Commercial	$153.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.85
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.98
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

SPECIFIC GRAVITY, BODY FLUID

Facility

$54.45

Service Code	HCPCS 84315
Hospital Charge Code	3008653
Hospital Revenue Code	301
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$10.63
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$3.28
Rate for Payer: Cigna Medicare Advantage	$1.64
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.28

SPECIFIC GRAVITY, BODY FLUID

Facility

$54.45

Service Code	HCPCS 84315
Hospital Charge Code	3008653
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$10.63
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$3.28
Rate for Payer: Cigna Medicare Advantage	$1.64
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.28

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$10.63
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$3.28
Rate for Payer: Cigna Medicare Advantage	$1.64
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
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	$3.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.28

Know your out-of-pocket cost for care.

All Charges