Heights University Hospital

All Charges

Charge

Type

Setting

Price

BYSTOLIC 20MG TABLE

Facility

$21.44

Service Code	NDC 456142030
Hospital Charge Code	60635788
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

BYSTOLIC 5MG TABLE

Facility

$22.91

Service Code	NDC 456140530
Hospital Charge Code	60635787
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

BYSTOLIC 5MG TABLE

Facility

$22.91

Service Code	NDC 456140530
Hospital Charge Code	60635787
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.84
Rate for Payer: Cigna Commercial	$11.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.98
Rate for Payer: Oxford Commercial	$11.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$11.46

C1 ESTERASE INHIBITOR

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476209
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.33
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476209
Hospital Revenue Code	302
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$51.15
Rate for Payer: Qualcare PPO/HMO/WC	$51.15

C1 ESTERASE INHIBITOR,FUN

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990024EX
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
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	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,FUN

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990024EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1 ESTERASE INHIBITOR FUNCTION

Facility

$86.00

Service Code	HCPCS 86161
Hospital Charge Code	3036035
Hospital Revenue Code	300
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

C1 ESTERASE INHIBITOR FUNCTION

Facility

$86.00

Service Code	HCPCS 86161
Hospital Charge Code	3036035
Hospital Revenue Code	300
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,FUN I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990024A
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,FUN I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990024A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,FUN II

Facility

$82.50

Service Code	HCPCS 86161
Hospital Charge Code	39990024B
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,FUN II

Facility

$82.50

Service Code	HCPCS 86161
Hospital Charge Code	39990024B
Hospital Revenue Code	306
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,TOT

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990025EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1 ESTERASE INHIBITOR,TOT

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990025EX
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
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	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,TOT I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990025A
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,TOT I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990025A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C1 ESTERASE INHIBITOR,TOT II

Facility

$82.50

Hospital Charge Code	39990025B
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,TOT II

Facility

$82.50

Hospital Charge Code	39990025B
Hospital Revenue Code	306
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$114.00

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.96
Rate for Payer: Aetna Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.29
Rate for Payer: Cigna Commercial	$24.37
Rate for Payer: Cigna Medicare Advantage	$12.19
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.83
Rate for Payer: Wellcare Medicare Advantage	$24.37

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
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	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

C2 SERUM

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3035152
Hospital Revenue Code	302
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$23.71
Rate for Payer: Qualcare PPO/HMO/WC	$23.71

C2 SERUM

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3035152
Hospital Revenue Code	302
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.88
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.97
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$6.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.71
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.72
Rate for Payer: Wellcare Medicare Advantage	$12.00

Know your out-of-pocket cost for care.

All Charges