Heights University Hospital

All Charges

Charge

Type

Setting

Price

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$51.09
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$117.90
Rate for Payer: Aetna Medicare Advantage	$117.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.22
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$85.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

*T&B LYMPHOCYTES DIFF PROFILE*

Facility

$89.00

Service Code	HCPCS 86355
Hospital Charge Code	3008706A
Hospital Revenue Code	305
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$138.24
Rate for Payer: Aetna Commercial	$122.25
Rate for Payer: Aetna Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.24
Rate for Payer: Cigna Commercial	$37.73
Rate for Payer: Cigna Medicare Advantage	$18.86
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$39.99
Rate for Payer: Wellcare Medicare Advantage	$37.73

*T&B LYMPHOCYTES DIFF PROFILE*

Facility

$89.00

Service Code	HCPCS 86355
Hospital Charge Code	3008706A
Hospital Revenue Code	305
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$602.68
Rate for Payer: Aetna Commercial	$602.68
Rate for Payer: Aetna Medicare Advantage	$602.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$486.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34

TB TEST-QUANTIFERON/AG-GI RS

Facility

$438.95

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$65.84
Max. Negotiated Rate	$65.84
Rate for Payer: Qualcare PPO/HMO/WC	$65.84

TB TEST-QUANTIFERON/AG-GI RS

Facility

$438.95

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$30.99
Max. Negotiated Rate	$227.09
Rate for Payer: Aetna Commercial	$200.82
Rate for Payer: Aetna Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.09
Rate for Payer: Cigna Commercial	$61.98
Rate for Payer: Cigna Medicare Advantage	$30.99
Rate for Payer: Clover Medicare Advantage	$58.88
Rate for Payer: EmblemHealth Commercial	$185.94
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.84
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$65.70
Rate for Payer: Wellcare Medicare Advantage	$61.98

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$875.81
Max. Negotiated Rate	$875.81
Rate for Payer: Qualcare PPO/HMO/WC	$875.81

TC99 EXAMETAZIME UP TO 25MCI

Facility

$5,838.74

Service Code	HCPCS A9521
Hospital Charge Code	4509072
Hospital Revenue Code	343
Min. Negotiated Rate	$759.04
Max. Negotiated Rate	$2,919.37
Rate for Payer: Aetna Commercial	$1,751.62
Rate for Payer: Aetna Medicare Advantage	$1,751.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,303.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,488.88
Rate for Payer: Cigna Commercial	$2,919.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.04
Rate for Payer: Qualcare PPO/HMO/WC	$875.81

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$778.16
Rate for Payer: Aetna Commercial	$77.60
Rate for Payer: Aetna Medicare Advantage	$77.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$778.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

TC99M CERETEC WBC 10,0 MCI

Facility

$258.67

Service Code	HCPCS A9569
Hospital Charge Code	4509093
Hospital Revenue Code	343
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$72.41
Max. Negotiated Rate	$278.50
Rate for Payer: Aetna Commercial	$167.10
Rate for Payer: Aetna Medicare Advantage	$167.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.03
Rate for Payer: Cigna Commercial	$278.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.41
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

TC99 MDP/STUDY UP TO 30 MCI

Facility

$557.00

Service Code	HCPCS A9503
Hospital Charge Code	36540018
Hospital Revenue Code	343
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.05

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$214.96
Max. Negotiated Rate	$214.96
Rate for Payer: Qualcare PPO/HMO/WC	$214.96

TC99MEB CHOLETECDOSEUPTO15MCI

Facility

$1,433.05

Service Code	HCPCS A9537
Hospital Charge Code	4500302
Hospital Revenue Code	343
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$716.52
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$429.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.43
Rate for Payer: Cigna Commercial	$716.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.30
Rate for Payer: Qualcare PPO/HMO/WC	$214.96

TC99 MERTIATIDE UP TO 15MCI

Facility

$1,024.34

Service Code	HCPCS A9562
Hospital Charge Code	4509083
Hospital Revenue Code	343
Min. Negotiated Rate	$133.16
Max. Negotiated Rate	$512.17
Rate for Payer: Aetna Commercial	$307.30
Rate for Payer: Aetna Medicare Advantage	$307.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$256.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.21
Rate for Payer: Cigna Commercial	$512.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.16
Rate for Payer: Qualcare PPO/HMO/WC	$153.65

TC99 MERTIATIDE UP TO 15MCI

Facility

$1,024.34

Service Code	HCPCS A9562
Hospital Charge Code	4509083
Hospital Revenue Code	343
Min. Negotiated Rate	$153.65
Max. Negotiated Rate	$153.65
Rate for Payer: Qualcare PPO/HMO/WC	$153.65

TC99M MEBROFENIN UP TO 15MCI

Facility

$140.00

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M MEBROFENIN UP TO 15MCI

Facility

$140.00

Service Code	HCPCS A9537
Hospital Charge Code	4509082
Hospital Revenue Code	343
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$119.68
Rate for Payer: Aetna Commercial	$19.85
Rate for Payer: Aetna Medicare Advantage	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.87
Rate for Payer: Cigna Commercial	$33.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.92

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$9.92
Rate for Payer: Qualcare PPO/HMO/WC	$9.92

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$41.14
Max. Negotiated Rate	$278.25
Rate for Payer: Aetna Commercial	$166.95
Rate for Payer: Aetna Medicare Advantage	$166.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.91
Rate for Payer: Cigna Commercial	$278.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.34
Rate for Payer: Qualcare PPO/HMO/WC	$83.47

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$83.47
Max. Negotiated Rate	$83.47
Rate for Payer: Qualcare PPO/HMO/WC	$83.47

TC99M SC FILTER/DOSE TO 20 MCI

Facility

$1,340.00

Service Code	HCPCS A9541
Hospital Charge Code	4509070
Hospital Revenue Code	343
Min. Negotiated Rate	$201.00
Max. Negotiated Rate	$201.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.00

Know your out-of-pocket cost for care.

All Charges