Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURE SWAB IX

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113I
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB V

Facility

$390.00

Service Code	HCPCS 87491
Hospital Charge Code	39990113E
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB V

Facility

$390.00

Service Code	HCPCS 87491
Hospital Charge Code	39990113E
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

SURE SWAB VI

Facility

$390.00

Service Code	HCPCS 87512
Hospital Charge Code	39990113F
Hospital Revenue Code	306
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$153.01
Rate for Payer: Aetna Commercial	$135.30
Rate for Payer: Aetna Medicare Advantage	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.01
Rate for Payer: Cigna Commercial	$41.76
Rate for Payer: Cigna Medicare Advantage	$20.88
Rate for Payer: Clover Medicare Advantage	$39.67
Rate for Payer: EmblemHealth Commercial	$125.28
Rate for Payer: Humana Medicare Advantage	$43.01
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	$41.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$44.27
Rate for Payer: Wellcare Medicare Advantage	$41.76

SURE SWAB VI

Facility

$390.00

Service Code	HCPCS 87512
Hospital Charge Code	39990113F
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB VII

Facility

$390.00

Service Code	HCPCS 87591
Hospital Charge Code	39990113G
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

SURE SWAB VII

Facility

$390.00

Service Code	HCPCS 87591
Hospital Charge Code	39990113G
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB VIII

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39990113H
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB VIII

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39990113H
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
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	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

SURFACE ARTIC LPGR 12 59964012

Facility

$4,285.50

Hospital Charge Code	270634654
Hospital Revenue Code	272
Min. Negotiated Rate	$642.83
Max. Negotiated Rate	$642.83
Rate for Payer: Qualcare PPO/HMO/WC	$642.83

SURFACE ARTIC LPGR 12 59964012

Facility

$4,285.50

Hospital Charge Code	270634654
Hospital Revenue Code	272
Min. Negotiated Rate	$557.12
Max. Negotiated Rate	$2,142.75
Rate for Payer: Aetna Commercial	$1,285.65
Rate for Payer: Aetna Medicare Advantage	$1,285.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.80
Rate for Payer: Cigna Commercial	$2,142.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.12
Rate for Payer: Oxford Commercial	$2,142.75
Rate for Payer: Qualcare PPO/HMO/WC	$642.83
Rate for Payer: UnitedHealthcare Commercial	$2,142.75

SURFACE ARTIC LPS 12m 59963212

Facility

$4,456.95

Hospital Charge Code	270633241
Hospital Revenue Code	272
Min. Negotiated Rate	$579.40
Max. Negotiated Rate	$2,228.47
Rate for Payer: Aetna Commercial	$1,337.09
Rate for Payer: Aetna Medicare Advantage	$1,337.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.52
Rate for Payer: Cigna Commercial	$2,228.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.40
Rate for Payer: Oxford Commercial	$2,228.47
Rate for Payer: Qualcare PPO/HMO/WC	$668.54
Rate for Payer: UnitedHealthcare Commercial	$2,228.47

SURFACE ARTIC LPS 12m 59963212

Facility

$4,456.95

Hospital Charge Code	270633241
Hospital Revenue Code	272
Min. Negotiated Rate	$668.54
Max. Negotiated Rate	$668.54
Rate for Payer: Qualcare PPO/HMO/WC	$668.54

SURFACE ARTIC LPS 5996-40-10

Facility

$5,571.07

Hospital Charge Code	623447
Hospital Revenue Code	278
Min. Negotiated Rate	$835.66
Max. Negotiated Rate	$1,348.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,114.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.20
Rate for Payer: Qualcare PPO/HMO/WC	$835.66

SURFACE ARTIC LPS 5996-40-10

Facility

$5,571.07

Hospital Charge Code	623447
Hospital Revenue Code	278
Min. Negotiated Rate	$835.66
Max. Negotiated Rate	$2,785.53
Rate for Payer: Aetna Commercial	$1,671.32
Rate for Payer: Aetna Medicare Advantage	$1,671.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,420.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,420.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,114.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,420.62
Rate for Payer: Cigna Commercial	$2,785.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.20
Rate for Payer: Qualcare PPO/HMO/WC	$835.66

SURFACE ARTIC NEXG 17 59723017

Facility

$3,614.70

Hospital Charge Code	270633100
Hospital Revenue Code	272
Min. Negotiated Rate	$469.91
Max. Negotiated Rate	$1,807.35
Rate for Payer: Aetna Commercial	$1,084.41
Rate for Payer: Aetna Medicare Advantage	$1,084.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.75
Rate for Payer: Cigna Commercial	$1,807.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$469.91
Rate for Payer: Oxford Commercial	$1,807.35
Rate for Payer: Qualcare PPO/HMO/WC	$542.21
Rate for Payer: UnitedHealthcare Commercial	$1,807.35

SURFACE ARTIC NEXG 17 59723017

Facility

$3,614.70

Hospital Charge Code	270633100
Hospital Revenue Code	272
Min. Negotiated Rate	$542.21
Max. Negotiated Rate	$542.21
Rate for Payer: Qualcare PPO/HMO/WC	$542.21

SURFACE ARTIC NEXGN 5972-40-17

Facility

$3,402.45

Hospital Charge Code	270608930
Hospital Revenue Code	278
Min. Negotiated Rate	$510.37
Max. Negotiated Rate	$1,701.22
Rate for Payer: Aetna Commercial	$1,020.74
Rate for Payer: Aetna Medicare Advantage	$1,020.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.62
Rate for Payer: Cigna Commercial	$1,701.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$823.39
Rate for Payer: Qualcare PPO/HMO/WC	$510.37

SURFACE ARTIC NEXGN 5972-40-17

Facility

$3,402.45

Hospital Charge Code	270608930
Hospital Revenue Code	278
Min. Negotiated Rate	$510.37
Max. Negotiated Rate	$823.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$823.39
Rate for Payer: Qualcare PPO/HMO/WC	$510.37

SURFACE ARTIC NEXGN 5982-40-10

Facility

$3,500.00

Hospital Charge Code	270615606
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$1,750.00

SURFACE ARTIC NEXGN 5982-40-10

Facility

$3,500.00

Hospital Charge Code	270615606
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

Know your out-of-pocket cost for care.

All Charges