Heights University Hospital

All Charges

Charge

Type

Setting

Price

TESTOSTERONE PROPIONATE/5

Facility

$56.00

Hospital Charge Code	60633991
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

TESTOSTERONE SERUM TOTAL

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3002532
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
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 SERUM TOTAL

Facility

$231.25

Service Code	HCPCS 84403
Hospital Charge Code	3002532
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

TESTOSTERONE,SERUM TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38479469
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$146.40
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.40
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,SERUM TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38479469
Hospital Revenue Code	301
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$146.40
Rate for Payer: Qualcare PPO/HMO/WC	$146.40

TESTOSTERONE,SERUM-TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38472635
Hospital Revenue Code	301
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$146.40
Rate for Payer: Qualcare PPO/HMO/WC	$146.40

TESTOSTERONE,SERUM-TOTAL

Facility

$976.00

Service Code	HCPCS 84403
Hospital Charge Code	38472635
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$146.40
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.40
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 TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERONE TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
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	$25.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.36
Rate for Payer: Wellcare Medicare Advantage	$25.81

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.62
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

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
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	$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	$25.47
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.00
Rate for Payer: Wellcare Medicare Advantage	$25.47

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$114.00
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: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
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	$25.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$27.36
Rate for Payer: Wellcare Medicare Advantage	$25.81

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TEST PREGNANCY HCG URINE

Facility

$5.00

Hospital Charge Code	270647381
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

TEST PREGNANCY HCG URINE

Facility

$5.00

Hospital Charge Code	270647381
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.23
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: Cigna Medicare Advantage	$7.40
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.69
Rate for Payer: Wellcare Medicare Advantage	$14.80

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

TETANUS ANTIBODY,IGG

Facility

$128.00

Service Code	HCPCS 86774
Hospital Charge Code	3000478
Hospital Revenue Code	302
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$47.95
Rate for Payer: Aetna Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.23
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: Cigna Medicare Advantage	$7.40
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.69
Rate for Payer: Wellcare Medicare Advantage	$14.80

TETANUS ANTIBODY,IGG

Facility

$128.00

Service Code	HCPCS 86774
Hospital Charge Code	3000478
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.52
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.48
Rate for Payer: Cigna Commercial	$14.05
Rate for Payer: Cigna Medicare Advantage	$7.03
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.89
Rate for Payer: Wellcare Medicare Advantage	$14.05

TETANUS ANTITOXN ANTIBOD IGG**

Facility

$150.00

Hospital Charge Code	3010477
Hospital Revenue Code	306
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

TETANUS ANTITOXN ANTIBOD IGG**

Facility

$150.00

Hospital Charge Code	3010477
Hospital Revenue Code	306
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges