Heights University Hospital

All Charges

Charge

Type

Setting

Price

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	94061181
Hospital Revenue Code	402
Min. Negotiated Rate	$96.68
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	94061181
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	2301057
Hospital Revenue Code	402
Min. Negotiated Rate	$96.68
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	2301057
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

TESTOSTERONE ESTR INJ

Facility

$53.80

Hospital Charge Code	6005185
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

TESTOSTERONE ESTR INJ

Facility

$53.80

Hospital Charge Code	6005185
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

TESTOSTERONE, FREE

Facility

$455.00

Service Code	HCPCS 84402
Hospital Charge Code	38472045
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.52
Rate for Payer: Aetna Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.32
Rate for Payer: Cigna Commercial	$25.47
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.00
Rate for Payer: Wellcare Medicare Advantage	$25.47

TESTOSTERONE, FREE

Facility

$455.00

Service Code	HCPCS 84402
Hospital Charge Code	38472045
Hospital Revenue Code	301
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

TESTOSTERONE, FREE

Facility

$167.25

Service Code	HCPCS 84402
Hospital Charge Code	3002533
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$82.52
Rate for Payer: Aetna Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.32
Rate for Payer: Cigna Commercial	$25.47
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.00
Rate for Payer: Wellcare Medicare Advantage	$25.47

TESTOSTERONE, FREE

Facility

$167.25

Service Code	HCPCS 84402
Hospital Charge Code	3002533
Hospital Revenue Code	301
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

TESTOSTERONE, FREE***

Facility

$55.00

Hospital Charge Code	3032398
Hospital Revenue Code	309
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.50
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.15
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

TESTOSTERONE, FREE***

Facility

$55.00

Hospital Charge Code	3032398
Hospital Revenue Code	309
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TESTOSTERONE, FREE, BIO/TOT

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	3035149B
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

TESTOSTERONE, FREE, BIO/TOT

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	3035149C
Hospital Revenue Code	307
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

TESTOSTERONE, FREE, BIO/TOT

Facility

$412.50

Hospital Charge Code	3035149
Hospital Revenue Code	301
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$61.88
Rate for Payer: Qualcare PPO/HMO/WC	$61.88

TESTOSTERONE, FREE, BIO/TOT

Facility

$549.00

Service Code	HCPCS 84403
Hospital Charge Code	3035149A
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: Aetna Commercial	$83.62
Rate for Payer: Aetna Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$25.81
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.36
Rate for Payer: Wellcare Medicare Advantage	$25.81

TESTOSTERONE, FREE, BIO/TOT

Facility

$281.00

Service Code	HCPCS 84270
Hospital Charge Code	3035149B
Hospital Revenue Code	301
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$70.41
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.62
Rate for Payer: Cigna Commercial	$21.73
Rate for Payer: Cigna Medicare Advantage	$10.87
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23.03
Rate for Payer: Wellcare Medicare Advantage	$21.73

TESTOSTERONE, FREE, BIO/TOT

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	3035149C
Hospital Revenue Code	307
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.14
Rate for Payer: Cigna Commercial	$4.95
Rate for Payer: Cigna Medicare Advantage	$2.48
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.25
Rate for Payer: Wellcare Medicare Advantage	$4.95

TESTOSTERONE, FREE, BIO/TOT

Facility

$549.00

Service Code	HCPCS 84403
Hospital Charge Code	3035149A
Hospital Revenue Code	301
Min. Negotiated Rate	$82.35
Max. Negotiated Rate	$82.35
Rate for Payer: Qualcare PPO/HMO/WC	$82.35

TESTOSTERONE, FREE, BIO/TOT

Facility

$412.50

Hospital Charge Code	3035149
Hospital Revenue Code	301
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$123.75
Rate for Payer: Aetna Medicare Advantage	$123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.19
Rate for Payer: Cigna Commercial	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.88
Rate for Payer: UnitedHealthcare Commercial	$114.00

TESTOSTERONE INJ 100MG /ML

Facility

$61.45

Hospital Charge Code	6005169
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

TESTOSTERONE INJ 100MG /ML

Facility

$61.45

Hospital Charge Code	6005169
Hospital Revenue Code	250
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.99
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$30.73

TESTOSTERONE PROPIONATE/1

Facility

$40.00

Hospital Charge Code	60633990
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

TESTOSTERONE PROPIONATE/1

Facility

$40.00

Hospital Charge Code	60633990
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

TESTOSTERONE PROPIONATE/5

Facility

$56.00

Hospital Charge Code	60633991
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

Know your out-of-pocket cost for care.

All Charges