Heights University Hospital

All Charges

Charge

Type

Setting

Price

STREP PNEUMO ANTIBODY VI

Facility

$390.00

Service Code	HCPCS 86317
Hospital Charge Code	39990145F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STREP PNEUMO ANTIGEN, URINE

Facility

$728.00

Service Code	HCPCS 87899
Hospital Charge Code	39990239
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

STREP PNEUMO ANTIGEN, URINE

Facility

$728.00

Service Code	HCPCS 87899
Hospital Charge Code	39990239
Hospital Revenue Code	306
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$109.20
Rate for Payer: Qualcare PPO/HMO/WC	$109.20

STREP SCREEN

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	87502745
Hospital Revenue Code	302
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.39
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$11.54
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
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	$11.54
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.23
Rate for Payer: Wellcare Medicare Advantage	$11.54

STREP SCREEN

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	87502745
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STREPTASE/250KU

Facility

$505.00

Hospital Charge Code	60633922
Hospital Revenue Code	636
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$122.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.21
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

STREPTASE/250KU

Facility

$505.00

Hospital Charge Code	60633922
Hospital Revenue Code	636
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.21
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

STREPTOCOCCUS, GROUP A

Facility

$77.95

Service Code	HCPCS 87880
Hospital Charge Code	38472339
Hospital Revenue Code	306
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.56
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.53
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	$60.57
Rate for Payer: Cigna Commercial	$16.53
Rate for Payer: Cigna Medicare Advantage	$8.27
Rate for Payer: Clover Medicare Advantage	$15.70
Rate for Payer: EmblemHealth Commercial	$49.59
Rate for Payer: Humana Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.52
Rate for Payer: Wellcare Medicare Advantage	$16.53

STREPTOCOCCUS, GROUP A

Facility

$77.95

Service Code	HCPCS 87880
Hospital Charge Code	38472339
Hospital Revenue Code	306
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

STREPTOCOCCUS GROUP A POC

Facility

$390.00

Service Code	HCPCS 87430
Hospital Charge Code	412387430
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STREPTOCOCCUS GROUP A POC

Facility

$390.00

Service Code	HCPCS 87430
Hospital Charge Code	412387430
Hospital Revenue Code	306
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.46
Rate for Payer: Aetna Medicare Advantage	$16.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.59
Rate for Payer: Cigna Commercial	$16.81
Rate for Payer: Cigna Medicare Advantage	$8.40
Rate for Payer: Clover Medicare Advantage	$15.97
Rate for Payer: EmblemHealth Commercial	$50.43
Rate for Payer: Humana Medicare Advantage	$17.31
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	$16.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.82
Rate for Payer: Wellcare Medicare Advantage	$16.81

STREPTOCOCCUS PNEMONIAE ANTIGE

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3038148
Hospital Revenue Code	306
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$52.07
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.88
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$8.04
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.03
Rate for Payer: Wellcare Medicare Advantage	$16.07

STREPTOCOCCUS PNEMONIAE ANTIGE

Facility

$231.25

Service Code	HCPCS 87899
Hospital Charge Code	3038148
Hospital Revenue Code	306
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

STREPTOKINASE 1.5 MIU/VIAL

Facility

$2,812.50

Hospital Charge Code	6016224
Hospital Revenue Code	636
Min. Negotiated Rate	$421.88
Max. Negotiated Rate	$1,406.25
Rate for Payer: Aetna Commercial	$843.75
Rate for Payer: Aetna Medicare Advantage	$843.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$717.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$717.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$717.19
Rate for Payer: Cigna Commercial	$1,406.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.62
Rate for Payer: Qualcare PPO/HMO/WC	$421.88

STREPTOKINASE 1.5 MIU/VIAL

Facility

$2,812.50

Hospital Charge Code	6016224
Hospital Revenue Code	636
Min. Negotiated Rate	$421.88
Max. Negotiated Rate	$680.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.62
Rate for Payer: Qualcare PPO/HMO/WC	$421.88

STREPTOKINASE/1.5MU

Facility

$1,206.00

Hospital Charge Code	60634981
Hospital Revenue Code	636
Min. Negotiated Rate	$180.90
Max. Negotiated Rate	$291.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90

STREPTOKINASE/1.5MU

Facility

$1,206.00

Hospital Charge Code	60634981
Hospital Revenue Code	636
Min. Negotiated Rate	$180.90
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$361.80
Rate for Payer: Aetna Medicare Advantage	$361.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.53
Rate for Payer: Cigna Commercial	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.85
Rate for Payer: Qualcare PPO/HMO/WC	$180.90

STREPTOKINASE 5000U/ML

Facility

$306.60

Hospital Charge Code	6006472
Hospital Revenue Code	636
Min. Negotiated Rate	$45.99
Max. Negotiated Rate	$153.30
Rate for Payer: Aetna Commercial	$91.98
Rate for Payer: Aetna Medicare Advantage	$91.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.18
Rate for Payer: Cigna Commercial	$153.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.99

STREPTOKINASE 5000U/ML

Facility

$306.60

Hospital Charge Code	6006472
Hospital Revenue Code	636
Min. Negotiated Rate	$45.99
Max. Negotiated Rate	$74.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.99

STREPTOKINASE INJ 250,000IU

Facility

$136.35

Hospital Charge Code	6005052
Hospital Revenue Code	636
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

STREPTOKINASE INJ 250,000IU

Facility

$136.35

Hospital Charge Code	6005052
Hospital Revenue Code	636
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$68.17
Rate for Payer: Aetna Commercial	$40.91
Rate for Payer: Aetna Medicare Advantage	$40.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.77
Rate for Payer: Cigna Commercial	$68.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.45

STREPTOKINASE INJ 250,000U

Facility

$666.70

Hospital Charge Code	60627539
Hospital Revenue Code	636
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$161.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.34
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

STREPTOKINASE INJ 250,000U

Facility

$666.70

Hospital Charge Code	60627539
Hospital Revenue Code	636
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$333.35
Rate for Payer: Aetna Commercial	$200.01
Rate for Payer: Aetna Medicare Advantage	$200.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.01
Rate for Payer: Cigna Commercial	$333.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.34
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

STREPTOKINASE INJ 750,000IU

Facility

$391.05

Hospital Charge Code	6005060
Hospital Revenue Code	636
Min. Negotiated Rate	$58.66
Max. Negotiated Rate	$94.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.63
Rate for Payer: Qualcare PPO/HMO/WC	$58.66

STREPTOKINASE INJ 750,000IU

Facility

$391.05

Hospital Charge Code	6005060
Hospital Revenue Code	636
Min. Negotiated Rate	$58.66
Max. Negotiated Rate	$195.53
Rate for Payer: Aetna Commercial	$117.31
Rate for Payer: Aetna Medicare Advantage	$117.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.72
Rate for Payer: Cigna Commercial	$195.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.63
Rate for Payer: Qualcare PPO/HMO/WC	$58.66

Know your out-of-pocket cost for care.

All Charges