Heights University Hospital

All Charges

Charge

Type

Setting

Price

TYPE AND CROSSMATCH (PAT)

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3101128
Hospital Revenue Code	300
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

TYPE AND CROSSMATCH (PAT)

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3101128
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TYPE AND CROSSMATCH (XTEND)

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3101110
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TYPE AND CROSSMATCH (XTEND)

Facility

$100.00

Service Code	HCPCS 86920
Hospital Charge Code	3101110
Hospital Revenue Code	300
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

TYPE AND SCREEN, PATIENT***

Facility

$188.00

Service Code	HCPCS 86900
Hospital Charge Code	3101151
Hospital Revenue Code	300
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$9.69
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$1.50
Rate for Payer: Clover Medicare Advantage	$2.84
Rate for Payer: EmblemHealth Commercial	$8.97
Rate for Payer: Humana Medicare Advantage	$3.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.17
Rate for Payer: Wellcare Medicare Advantage	$2.99

TYPE AND SCREEN, PATIENT***

Facility

$188.00

Service Code	HCPCS 86900
Hospital Charge Code	3101151
Hospital Revenue Code	300
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

TYROSINE

Facility

$73.64

Service Code	HCPCS 84510
Hospital Charge Code	38477072
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$34.44
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.95
Rate for Payer: Cigna Commercial	$10.63
Rate for Payer: Cigna Medicare Advantage	$5.32
Rate for Payer: Clover Medicare Advantage	$10.10
Rate for Payer: EmblemHealth Commercial	$31.89
Rate for Payer: Humana Medicare Advantage	$10.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.27
Rate for Payer: Wellcare Medicare Advantage	$10.63

TYROSINE

Facility

$73.64

Service Code	HCPCS 84510
Hospital Charge Code	38477072
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

TZANCK SMEAR***

Facility

$66.00

Hospital Charge Code	3010469
Hospital Revenue Code	309
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$114.00

TZANCK SMEAR***

Facility

$66.00

Hospital Charge Code	3010469
Hospital Revenue Code	309
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

TZANCK SMEAR GENITAL FEM)902**

Facility

$25.00

Hospital Charge Code	3010931
Hospital Revenue Code	306
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

TZANCK SMEAR GENITAL FEM)902**

Facility

$25.00

Hospital Charge Code	3010931
Hospital Revenue Code	306
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: Cigna Medicare Advantage	$1.74
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
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	$3.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.69
Rate for Payer: Wellcare Medicare Advantage	$3.48

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

U-BLADE LAG SCREW SET TITANIUM

Facility

$6,140.00

Hospital Charge Code	270658001
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

U-BLADE LAG SCREW SET TITANIUM

Facility

$6,140.00

Hospital Charge Code	270658001
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$1,842.00
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

U BLADE SET, TI

Facility

$5,740.00

Hospital Charge Code	270658000
Hospital Revenue Code	272
Min. Negotiated Rate	$746.20
Max. Negotiated Rate	$2,870.00
Rate for Payer: Aetna Commercial	$1,722.00
Rate for Payer: Aetna Medicare Advantage	$1,722.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.70
Rate for Payer: Cigna Commercial	$2,870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$746.20
Rate for Payer: Oxford Commercial	$2,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$861.00
Rate for Payer: UnitedHealthcare Commercial	$2,870.00

U BLADE SET, TI

Facility

$5,740.00

Hospital Charge Code	270658000
Hospital Revenue Code	272
Min. Negotiated Rate	$861.00
Max. Negotiated Rate	$861.00
Rate for Payer: Qualcare PPO/HMO/WC	$861.00

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

U CALCIUM RANDOM***

Facility

$21.00

Hospital Charge Code	3010584
Hospital Revenue Code	301
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$114.00

U CALCIUM RANDOM***

Facility

$21.00

Hospital Charge Code	3010584
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.75
Rate for Payer: Oxford Commercial	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$1,237.50

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$89.54
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$320.08
Rate for Payer: Aetna Medicare Advantage	$320.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.07
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.04
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

Know your out-of-pocket cost for care.

All Charges