Heights University Hospital

All Charges

Charge

Type

Setting

Price

T3 TOTAL

Facility

$667.59

Service Code	HCPCS 84480
Hospital Charge Code	3003712
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

T3 TOTAL

Facility

$667.59

Service Code	HCPCS 84480
Hospital Charge Code	3003712
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

T3 (TRIIODOTHYRONINE)

Facility

$295.00

Service Code	HCPCS 84480
Hospital Charge Code	38472623
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.94
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.96
Rate for Payer: Cigna Commercial	$14.18
Rate for Payer: Cigna Medicare Advantage	$7.09
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.03
Rate for Payer: Wellcare Medicare Advantage	$14.18

T3 (TRIIODOTHYRONINE)

Facility

$295.00

Service Code	HCPCS 84480
Hospital Charge Code	38472623
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$20.96
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.71
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: Cigna Medicare Advantage	$3.23
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.86
Rate for Payer: Wellcare Medicare Advantage	$6.47

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$29.22
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
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	$33.05
Rate for Payer: Cigna Commercial	$9.02
Rate for Payer: Cigna Medicare Advantage	$4.51
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.13
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.56
Rate for Payer: Wellcare Medicare Advantage	$9.02

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$95.13
Rate for Payer: Qualcare PPO/HMO/WC	$95.13

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$116.31
Rate for Payer: Aetna Commercial	$29.22
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
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	$33.05
Rate for Payer: Cigna Commercial	$9.02
Rate for Payer: Cigna Medicare Advantage	$4.51
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.31
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.56
Rate for Payer: Wellcare Medicare Advantage	$9.02

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$116.31
Max. Negotiated Rate	$116.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.31

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$49.02
Rate for Payer: Aetna Commercial	$29.41
Rate for Payer: Aetna Medicare Advantage	$29.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.00
Rate for Payer: Cigna Commercial	$49.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$49.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$49.02

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

T4 PERSONAL PROTECTIVE SEPTEM

Facility

$5,314.05

Hospital Charge Code	270656389
Hospital Revenue Code	272
Min. Negotiated Rate	$690.83
Max. Negotiated Rate	$2,657.03
Rate for Payer: Aetna Commercial	$1,594.21
Rate for Payer: Aetna Medicare Advantage	$1,594.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,355.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,355.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,355.08
Rate for Payer: Cigna Commercial	$2,657.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.83
Rate for Payer: Oxford Commercial	$2,657.03
Rate for Payer: Qualcare PPO/HMO/WC	$797.11
Rate for Payer: UnitedHealthcare Commercial	$2,657.03

T4 PERSONAL PROTECTIVE SEPTEM

Facility

$5,314.05

Hospital Charge Code	270656389
Hospital Revenue Code	272
Min. Negotiated Rate	$797.11
Max. Negotiated Rate	$797.11
Rate for Payer: Qualcare PPO/HMO/WC	$797.11

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$59.22
Rate for Payer: Qualcare PPO/HMO/WC	$59.22

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.26
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.17
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: Cigna Medicare Advantage	$3.44
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.22
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.28
Rate for Payer: Wellcare Medicare Advantage	$6.87

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$101.37
Max. Negotiated Rate	$101.37
Rate for Payer: Qualcare PPO/HMO/WC	$101.37

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$22.26
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.17
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: Cigna Medicare Advantage	$3.44
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.37
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.28
Rate for Payer: Wellcare Medicare Advantage	$6.87

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$122.70
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Oxford Commercial	$204.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$204.50

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$122.70
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Oxford Commercial	$204.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$204.50

Know your out-of-pocket cost for care.

All Charges