Heights University Hospital

All Charges

Charge

Type

Setting

Price

WEST NILE VIRUS AB SERUM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035042A
Hospital Revenue Code	302
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

WEST NILE VIRUS ANTIBOD CSF II

Facility

$101.95

Service Code	HCPCS 86789
Hospital Charge Code	3037040B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$15.29
Rate for Payer: Qualcare PPO/HMO/WC	$15.29

WEST NILE VIRUS ANTIBOD CSF II

Facility

$101.95

Service Code	HCPCS 86789
Hospital Charge Code	3037040B
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	$37.61
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	$13.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.29
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

WEST NILE VIRUS, ANTIBODY

Facility

$101.94

Service Code	HCPCS 86789
Hospital Charge Code	38472343
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	$37.61
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	$13.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.29
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

WEST NILE VIRUS, ANTIBODY

Facility

$101.94

Service Code	HCPCS 86789
Hospital Charge Code	38472343
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$15.29
Rate for Payer: Qualcare PPO/HMO/WC	$15.29

WEST NILE VIRUS ANTIBODY CSF I

Facility

$119.30

Service Code	HCPCS 86788
Hospital Charge Code	3037040A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

WEST NILE VIRUS ANTIBODY CSF I

Facility

$119.30

Service Code	HCPCS 86788
Hospital Charge Code	3037040A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

WEST NILE VIRUS,IGM-ANTIBODY

Facility

$119.00

Service Code	HCPCS 86788
Hospital Charge Code	38472342
Hospital Revenue Code	302
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

WEST NILE VIRUS,IGM-ANTIBODY

Facility

$119.00

Service Code	HCPCS 86788
Hospital Charge Code	38472342
Hospital Revenue Code	302
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.74
Rate for Payer: Cigna Commercial	$16.85
Rate for Payer: Cigna Medicare Advantage	$8.43
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.86
Rate for Payer: Wellcare Medicare Advantage	$16.85

WET FIELD ERASER

Facility

$335.00

Hospital Charge Code	270656601
Hospital Revenue Code	270
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$167.50
Rate for Payer: Aetna Commercial	$100.50
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.55
Rate for Payer: Oxford Commercial	$167.50
Rate for Payer: Qualcare PPO/HMO/WC	$50.25
Rate for Payer: UnitedHealthcare Commercial	$167.50

WET FIELD ERASER

Facility

$335.00

Hospital Charge Code	270656601
Hospital Revenue Code	270
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

WETFIELD FORCEP

Facility

$1,280.00

Hospital Charge Code	270658118
Hospital Revenue Code	272
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$192.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.00

WETFIELD FORCEP

Facility

$1,280.00

Hospital Charge Code	270658118
Hospital Revenue Code	272
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$640.00
Rate for Payer: Aetna Commercial	$384.00
Rate for Payer: Aetna Medicare Advantage	$384.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$326.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$326.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$326.40
Rate for Payer: Cigna Commercial	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.40
Rate for Payer: Oxford Commercial	$640.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.00
Rate for Payer: UnitedHealthcare Commercial	$640.00

WET MOUNT/KOH

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	87502755
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WET MOUNT/KOH

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	87502755
Hospital Revenue Code	309
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
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	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

WET PREP

Facility

$43.25

Service Code	HCPCS 87210
Hospital Charge Code	3000163
Hospital Revenue Code	309
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

WET PREP

Facility

$43.25

Service Code	HCPCS 87210
Hospital Charge Code	3000163
Hospital Revenue Code	309
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.32
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: Cigna Medicare Advantage	$2.91
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.17
Rate for Payer: Wellcare Medicare Advantage	$5.82

WET PREP***

Facility

$14.00

Hospital Charge Code	3010162
Hospital Revenue Code	306
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$114.00

WET PREP***

Facility

$14.00

Hospital Charge Code	3010162
Hospital Revenue Code	306
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

WET SMEAR WHC****

Facility

$2.64

Service Code	HCPCS Q0111
Hospital Charge Code	9600032
Hospital Revenue Code	309
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.07
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.93
Rate for Payer: Cigna Commercial	$18.54
Rate for Payer: Cigna Medicare Advantage	$9.27
Rate for Payer: Clover Medicare Advantage	$17.61
Rate for Payer: EmblemHealth Commercial	$55.62
Rate for Payer: Humana Medicare Advantage	$19.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.54
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.65
Rate for Payer: Wellcare Medicare Advantage	$18.54

WET SMEAR WHC****

Facility

$2.64

Service Code	HCPCS Q0111
Hospital Charge Code	9600032
Hospital Revenue Code	309
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.40

WEZLANA 90MG /ML INJ

Facility

$36,376.71

Service Code	NDC 84612088901
Hospital Charge Code	6064943029
Hospital Revenue Code	250
Min. Negotiated Rate	$4,728.97
Max. Negotiated Rate	$18,188.35
Rate for Payer: Aetna Commercial	$10,913.01
Rate for Payer: Aetna Medicare Advantage	$10,913.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,276.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,276.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,276.06
Rate for Payer: Cigna Commercial	$18,188.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,728.97
Rate for Payer: Oxford Commercial	$18,188.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,456.51
Rate for Payer: UnitedHealthcare Commercial	$18,188.35

WEZLANA 90MG /ML INJ

Facility

$36,376.71

Service Code	NDC 84612088901
Hospital Charge Code	6064943029
Hospital Revenue Code	250
Min. Negotiated Rate	$5,456.51
Max. Negotiated Rate	$5,456.51
Rate for Payer: Qualcare PPO/HMO/WC	$5,456.51

WHC BILATERAL MAMMOGRAM DIAG

Facility

$147.00

Service Code	HCPCS 76091
Hospital Charge Code	2003028
Hospital Revenue Code	401
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.11
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

WHC BILATERAL MAMMOGRAM DIAG

Facility

$147.00

Service Code	HCPCS 76091
Hospital Charge Code	2003028
Hospital Revenue Code	401
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

Know your out-of-pocket cost for care.

All Charges