Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLN DX PAT-TOES-BILAT

Facility

$250.00

Service Code	HCPCS 7366050
Hospital Charge Code	75190370
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-WRIST 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7311050
Hospital Charge Code	75190315
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-WRIST 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7311050
Hospital Charge Code	75190315
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST 3 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73110LT
Hospital Charge Code	75190415
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLN DX PAT-WRIST 3 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73110LT
Hospital Charge Code	75190415
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST 3 VIEWS-RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	75190420
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

CLN DX PAT-WRIST 3 VIEWS-RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	75190420
Hospital Revenue Code	320
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST AP&LAT 2-LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	75190405
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

CLN DX PAT-WRIST AP&LAT 2-LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	75190405
Hospital Revenue Code	320
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$76.20
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST AP&LAT 2-RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	75190410
Hospital Revenue Code	320
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$76.20
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST AP&LAT 2-RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	75190410
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

CLN DX PAT-WRIST AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	75190310
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-WRIST AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	75190310
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN EXC BENIGN DIAM 1.1-2.0 CM

Facility

$3,472.65

Service Code	HCPCS 11442
Hospital Charge Code	75190085
Hospital Revenue Code	761
Min. Negotiated Rate	$63.83
Max. Negotiated Rate	$1,736.33
Rate for Payer: Aetna Commercial	$1,041.80
Rate for Payer: Aetna Medicare Advantage	$1,041.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.53
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.44
Rate for Payer: Oxford Commercial	$1,736.33
Rate for Payer: Qualcare PPO/HMO/WC	$520.90
Rate for Payer: UnitedHealthcare Commercial	$1,736.33

CLN EXC BENIGN DIAM 1.1-2.0 CM

Facility

$3,472.65

Service Code	HCPCS 11442
Hospital Charge Code	75190085
Hospital Revenue Code	761
Min. Negotiated Rate	$520.90
Max. Negotiated Rate	$520.90
Rate for Payer: Qualcare PPO/HMO/WC	$520.90

CLN EXC EXT THROMBOSED HEMOR

Facility

$10,145.56

Service Code	HCPCS 46320
Hospital Charge Code	75190150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,318.92
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$3,043.67
Rate for Payer: Aetna Medicare Advantage	$3,043.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,587.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,587.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,587.12
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,318.92
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.83
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CLN EXC EXT THROMBOSED HEMOR

Facility

$10,145.56

Service Code	HCPCS 46320
Hospital Charge Code	75190150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,521.83
Max. Negotiated Rate	$1,521.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.83

CLN FNA BREAST BX

Facility

$669.90

Service Code	HCPCS 10021
Hospital Charge Code	75190001
Hospital Revenue Code	761
Min. Negotiated Rate	$87.09
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$200.97
Rate for Payer: Aetna Medicare Advantage	$200.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.82
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.09
Rate for Payer: Oxford Commercial	$334.95
Rate for Payer: Qualcare PPO/HMO/WC	$100.48
Rate for Payer: UnitedHealthcare Commercial	$334.95

CLN FNA BREAST BX

Facility

$669.90

Service Code	HCPCS 10021
Hospital Charge Code	75190001
Hospital Revenue Code	761
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$100.48
Rate for Payer: Qualcare PPO/HMO/WC	$100.48

CLN INJ TRIGGER POINTS,=/>3

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	75190125
Hospital Revenue Code	361
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$327.30
Rate for Payer: Aetna Medicare Advantage	$327.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.20
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.83
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

CLN INJ TRIGGER POINTS,=/>3

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	75190125
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

CLNOSCOPY PROXIMAL W/BIOPSY***

Facility

$1,026.00

Hospital Charge Code	2300011
Hospital Revenue Code	759
Min. Negotiated Rate	$133.38
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna Commercial	$307.80
Rate for Payer: Aetna Medicare Advantage	$307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.63
Rate for Payer: Cigna Commercial	$513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.38
Rate for Payer: Qualcare PPO/HMO/WC	$153.90

CLNOSCOPY PROXIMAL W/BIOPSY***

Facility

$1,026.00

Hospital Charge Code	2300011
Hospital Revenue Code	759
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$153.90
Rate for Payer: Qualcare PPO/HMO/WC	$153.90

CLN OV EP COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	75190230
Hospital Revenue Code	510
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$364.14
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

CLN OV EP COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	75190230
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

Know your out-of-pocket cost for care.

All Charges