Heights University Hospital

All Charges

Charge

Type

Setting

Price

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
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	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

B PERTUSSIS IGG/M/A AB II

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075B
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

B PERTUSSIS IGG/M/A AB II

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075B
Hospital Revenue Code	302
Min. Negotiated Rate	$19.75
Max. Negotiated Rate	$19.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.75

B PERTUSSIS IGG/M/A AB III

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075C
Hospital Revenue Code	302
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.74
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: Cigna Medicare Advantage	$6.59
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.98
Rate for Payer: Wellcare Medicare Advantage	$13.19

B PERTUSSIS IGG/M/A AB III

Facility

$131.65

Service Code	HCPCS 86615
Hospital Charge Code	3038075C
Hospital Revenue Code	302
Min. Negotiated Rate	$19.75
Max. Negotiated Rate	$19.75
Rate for Payer: Qualcare PPO/HMO/WC	$19.75

BPSY NDLE FRNSEN LUNG 22CM10CM

Facility

$24.35

Hospital Charge Code	270658318
Hospital Revenue Code	272
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$12.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$12.18

BPSY NDLE FRNSEN LUNG 22CM10CM

Facility

$24.35

Hospital Charge Code	270658318
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

BPSY NDLE FRNSEN LUNG 22CM15CM

Facility

$24.35

Hospital Charge Code	270658320
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

BPSY NDLE FRNSEN LUNG 22CM15CM

Facility

$24.35

Hospital Charge Code	270658320
Hospital Revenue Code	272
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$12.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$12.18

B.QUINTANA

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072B
Hospital Revenue Code	300
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

B.QUINTANA

Facility

$70.65

Service Code	HCPCS 86611
Hospital Charge Code	3035072B
Hospital Revenue Code	300
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$32.98
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.30
Rate for Payer: Cigna Commercial	$10.18
Rate for Payer: Cigna Medicare Advantage	$5.09
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.79
Rate for Payer: Wellcare Medicare Advantage	$10.18

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$3,595.35
Rate for Payer: Aetna Commercial	$2,157.21
Rate for Payer: Aetna Medicare Advantage	$2,157.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,833.63
Rate for Payer: Cigna Commercial	$3,595.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61
Rate for Payer: UnitedHealthcare Commercial	$114.00

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$1,456.80
Rate for Payer: Aetna Commercial	$874.08
Rate for Payer: Aetna Medicare Advantage	$874.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.97
Rate for Payer: Cigna Commercial	$1,456.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.04
Rate for Payer: UnitedHealthcare Commercial	$114.00

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$437.04
Max. Negotiated Rate	$437.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.04

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$1,078.61
Max. Negotiated Rate	$1,078.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61

BRACE AIR STIRRUP ******

Facility

$158.00

Hospital Charge Code	8003063
Hospital Revenue Code	279
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

BRACE AIR STIRRUP ******

Facility

$158.00

Hospital Charge Code	8003063
Hospital Revenue Code	279
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$47.40
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$79.00

BRACE ANKLE *********

Facility

$110.00

Hospital Charge Code	8003311
Hospital Revenue Code	279
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

BRACE ANKLE *********

Facility

$110.00

Hospital Charge Code	8003311
Hospital Revenue Code	279
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

BRACE ANKLE LEFT PEDIATRIC

Facility

$97.50

Hospital Charge Code	270667755
Hospital Revenue Code	270
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna Commercial	$29.25
Rate for Payer: Aetna Medicare Advantage	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.86
Rate for Payer: Cigna Commercial	$48.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Oxford Commercial	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$14.62
Rate for Payer: UnitedHealthcare Commercial	$48.75

BRACE ANKLE LEFT PEDIATRIC

Facility

$97.50

Hospital Charge Code	270667755
Hospital Revenue Code	270
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$14.62
Rate for Payer: Qualcare PPO/HMO/WC	$14.62

BRACE ANKLE LEFT SMALL

Facility

$119.50

Hospital Charge Code	270653991
Hospital Revenue Code	272
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$17.93

BRACE ANKLE LEFT SMALL

Facility

$119.50

Hospital Charge Code	270653991
Hospital Revenue Code	272
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$59.75
Rate for Payer: Aetna Commercial	$35.85
Rate for Payer: Aetna Medicare Advantage	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.47
Rate for Payer: Cigna Commercial	$59.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.54
Rate for Payer: Oxford Commercial	$59.75
Rate for Payer: Qualcare PPO/HMO/WC	$17.93
Rate for Payer: UnitedHealthcare Commercial	$59.75

Know your out-of-pocket cost for care.

All Charges