Heights University Hospital

All Charges

Charge

Type

Setting

Price

BILIRUBIN, URINE

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	3003878
Hospital Revenue Code	307
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

BILI TRANS POST

Facility

$390.00

Service Code	HCPCS 82247
Hospital Charge Code	300439
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BILI TRANS POST

Facility

$390.00

Service Code	HCPCS 82247
Hospital Charge Code	300439
Hospital Revenue Code	301
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.02
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	$18.39
Rate for Payer: Cigna Commercial	$5.02
Rate for Payer: Cigna Medicare Advantage	$2.51
Rate for Payer: Clover Medicare Advantage	$4.77
Rate for Payer: EmblemHealth Commercial	$15.06
Rate for Payer: Humana Medicare Advantage	$5.17
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	$5.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.32
Rate for Payer: Wellcare Medicare Advantage	$5.02

BILL ADMIN COMPONENT 1-6 UNITS

Facility

$82.00

Service Code	HCPCS 36430
Hospital Charge Code	3100468
Hospital Revenue Code	391
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$1,050.61
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$756.00

BILL ADMIN COMPONENT 1-6 UNITS

Facility

$82.00

Service Code	HCPCS 36430
Hospital Charge Code	3100468
Hospital Revenue Code	391
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

BILL AG SCREEN BLD UNIIT, IGG

Facility

$390.00

Service Code	HCPCS 86905
Hospital Charge Code	3100211
Hospital Revenue Code	300
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$12.41
Rate for Payer: Aetna Medicare Advantage	$3.83
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) Medicare Advantage	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$1.92
Rate for Payer: Clover Medicare Advantage	$3.64
Rate for Payer: EmblemHealth Commercial	$11.49
Rate for Payer: Humana Medicare Advantage	$3.94
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	$3.83
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.06
Rate for Payer: Wellcare Medicare Advantage	$3.83

BILL AG SCREEN BLD UNIIT, IGG

Facility

$390.00

Service Code	HCPCS 86905
Hospital Charge Code	3100211
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BILL AG SCREEN PATIENT, IGG

Facility

$309.65

Service Code	HCPCS 86904
Hospital Charge Code	3100419
Hospital Revenue Code	300
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$52.94
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.87
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$15.52
Rate for Payer: EmblemHealth Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$16.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.32
Rate for Payer: Wellcare Medicare Advantage	$16.34

BILL AG SCREEN PATIENT, IGG

Facility

$309.65

Service Code	HCPCS 86904
Hospital Charge Code	3100419
Hospital Revenue Code	300
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$46.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BILL ANTIGEN NEG-BLOOD, GNYBP

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100484
Hospital Revenue Code	309
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$66.25
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$114.00

BILL ANTIGEN NEG-BLOOD, GNYBP

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100484
Hospital Revenue Code	309
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

BILL ANTIGEN NEG BLOOD,NOJBC

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100476
Hospital Revenue Code	309
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$66.25
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$114.00

BILL ANTIGEN NEG BLOOD,NOJBC

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100476
Hospital Revenue Code	309
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

BILL BLOOD ADMINISTRATION

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3100054
Hospital Revenue Code	391
Min. Negotiated Rate	$182.49
Max. Negotiated Rate	$1,050.61
Rate for Payer: Aetna Commercial	$421.12
Rate for Payer: Aetna Medicare Advantage	$421.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.96
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.49
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.56
Rate for Payer: UnitedHealthcare Commercial	$756.00

BILL BLOOD ADMINISTRATION

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3100054
Hospital Revenue Code	391
Min. Negotiated Rate	$210.56
Max. Negotiated Rate	$210.56
Rate for Payer: Qualcare PPO/HMO/WC	$210.56

BILL CMV NEG BLOOD ORDER

Facility

$188.85

Service Code	HCPCS 86644
Hospital Charge Code	3100500
Hospital Revenue Code	302
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$28.33
Rate for Payer: Qualcare PPO/HMO/WC	$28.33

BILL CMV NEG BLOOD ORDER

Facility

$188.85

Service Code	HCPCS 86644
Hospital Charge Code	3100500
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.62
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.72
Rate for Payer: Cigna Commercial	$14.39
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.33
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.25
Rate for Payer: Wellcare Medicare Advantage	$14.39

BILL FFP

Facility

$170.25

Hospital Charge Code	3100021
Hospital Revenue Code	390
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$51.08
Rate for Payer: Aetna Medicare Advantage	$51.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.41
Rate for Payer: Cigna Commercial	$85.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.13
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.54
Rate for Payer: UnitedHealthcare Commercial	$756.00

BILL FFP

Facility

$170.25

Hospital Charge Code	3100021
Hospital Revenue Code	390
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$25.54
Rate for Payer: Qualcare PPO/HMO/WC	$25.54

BILL HEMOGLOBIN S NEG BLOOD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100492
Hospital Revenue Code	300
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

BILL HEMOGLOBIN S NEG BLOOD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100492
Hospital Revenue Code	300
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$66.25
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$114.00

BILL PHERESIS PLTS, SGL DONOR

Facility

$40.17

Service Code	HCPCS 86985
Hospital Charge Code	3100120
Hospital Revenue Code	390
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

BILL PHERESIS PLTS, SGL DONOR

Facility

$40.17

Service Code	HCPCS 86985
Hospital Charge Code	3100120
Hospital Revenue Code	390
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$12.05
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.24
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.22
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$756.00

BILL PLATELETS

Facility

$174.75

Hospital Charge Code	3100047
Hospital Revenue Code	390
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

BILL PLATELETS

Facility

$174.75

Hospital Charge Code	3100047
Hospital Revenue Code	390
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$52.42
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.72
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$756.00

Know your out-of-pocket cost for care.

All Charges