Heights University Hospital

All Charges

Charge

Type

Setting

Price

TEICHOIC ACID TITER

Facility

$96.50

Service Code	HCPCS 86329
Hospital Charge Code	39900212
Hospital Revenue Code	302
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Qualcare PPO/HMO/WC	$14.47

TEICHOIC ACID W/TITER RFX

Facility

$390.00

Service Code	HCPCS 86331
Hospital Charge Code	39900410
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
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	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

TEICHOIC ACID W/TITER RFX

Facility

$390.00

Service Code	HCPCS 86331
Hospital Charge Code	39900410
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4855Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$19.99
Rate for Payer: Qualcare PPO/HMO/WC	$19.99

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4850Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$19.99
Rate for Payer: Qualcare PPO/HMO/WC	$19.99

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4855Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$66.62
Rate for Payer: Aetna Commercial	$39.98
Rate for Payer: Aetna Medicare Advantage	$39.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.98
Rate for Payer: Cigna Commercial	$66.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.32
Rate for Payer: Oxford Commercial	$66.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.99
Rate for Payer: UnitedHealthcare Commercial	$66.62

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4850Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$66.62
Rate for Payer: Aetna Commercial	$39.98
Rate for Payer: Aetna Medicare Advantage	$39.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.98
Rate for Payer: Cigna Commercial	$66.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.32
Rate for Payer: Oxford Commercial	$66.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.99
Rate for Payer: UnitedHealthcare Commercial	$66.62

TELEMETRY MONITORING******

Facility

$98.00

Service Code	HCPCS 99999
Hospital Charge Code	5800016
Hospital Revenue Code	732
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$1,592.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$1,592.00

TELEMETRY MONITORING******

Facility

$98.00

Service Code	HCPCS 99999
Hospital Charge Code	5800016
Hospital Revenue Code	732
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315
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

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315N
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELEPORT 2.1F 150CM

Facility

$3,500.00

Hospital Charge Code	270686315N
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

TELEPORT MICRO CATH 135CM 21FR

Facility

$3,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270692099
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
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) NJ Health	$700.00
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	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELEPORT MICRO CATH 135CM 21FR

Facility

$3,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270692099
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TELESCOPIC STRUT GOLD

Facility

$6,644.50

Hospital Charge Code	270702657
Hospital Revenue Code	278
Min. Negotiated Rate	$996.67
Max. Negotiated Rate	$3,322.25
Rate for Payer: Aetna Commercial	$1,993.35
Rate for Payer: Aetna Medicare Advantage	$1,993.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.35
Rate for Payer: Cigna Commercial	$3,322.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: Qualcare PPO/HMO/WC	$996.67

TELESCOPIC STRUT GOLD

Facility

$6,644.50

Hospital Charge Code	270702657
Hospital Revenue Code	278
Min. Negotiated Rate	$996.67
Max. Negotiated Rate	$1,607.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: Qualcare PPO/HMO/WC	$996.67

TELES.STRUT LONG 177-277MM RED

Facility

$6,479.60

Hospital Charge Code	270702827
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$3,239.80
Rate for Payer: Aetna Commercial	$1,943.88
Rate for Payer: Aetna Medicare Advantage	$1,943.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,652.30
Rate for Payer: Cigna Commercial	$3,239.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELES.STRUT LONG 177-277MM RED

Facility

$6,479.60

Hospital Charge Code	270702827
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$1,568.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELES.STRUT SHRT 119-161MM BLU

Facility

$6,479.60

Hospital Charge Code	270702826
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$3,239.80
Rate for Payer: Aetna Commercial	$1,943.88
Rate for Payer: Aetna Medicare Advantage	$1,943.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,652.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,652.30
Rate for Payer: Cigna Commercial	$3,239.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELES.STRUT SHRT 119-161MM BLU

Facility

$6,479.60

Hospital Charge Code	270702826
Hospital Revenue Code	278
Min. Negotiated Rate	$971.94
Max. Negotiated Rate	$1,568.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$971.94

TELETHX ISODOSE PLAN CPLX

Facility

$671.79

Service Code	HCPCS 77307
Hospital Charge Code	85000892
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

TELETHX ISODOSE PLAN CPLX

Facility

$671.79

Service Code	HCPCS 77307
Hospital Charge Code	85000892
Hospital Revenue Code	333
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$201.54
Rate for Payer: Aetna Medicare Advantage	$201.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.31
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.33
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$201.54
Rate for Payer: Aetna Medicare Advantage	$201.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.31
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.33
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

Know your out-of-pocket cost for care.

All Charges