Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT ORBIT W/ CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70481
Hospital Charge Code	2205481
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ORBIT W/ CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70481
Hospital Charge Code	2205481
Hospital Revenue Code	351
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$233.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT ORBIT WO C

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200251
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ORBIT WO C

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200251
Hospital Revenue Code	351
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT ORBIT W & W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70482
Hospital Charge Code	2205480
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ORBIT W & W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70482
Hospital Charge Code	2205480
Hospital Revenue Code	351
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT PARACENTESIS W/O IMAGING

Facility

$4,890.30

Service Code	HCPCS 49082
Hospital Charge Code	2205128
Hospital Revenue Code	361
Min. Negotiated Rate	$733.54
Max. Negotiated Rate	$733.54
Rate for Payer: Qualcare PPO/HMO/WC	$733.54

CT PARACENTESIS W/O IMAGING

Facility

$4,890.30

Service Code	HCPCS 49082
Hospital Charge Code	2205128
Hospital Revenue Code	361
Min. Negotiated Rate	$635.74
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,467.09
Rate for Payer: Aetna Medicare Advantage	$1,467.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,247.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,247.03
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	$1,247.03
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$733.54
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CT PELVIMETRY

Facility

$488.00

Service Code	HCPCS 74710
Hospital Charge Code	2200079
Hospital Revenue Code	329
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$73.20

CT PELVIMETRY

Facility

$488.00

Service Code	HCPCS 74710
Hospital Charge Code	2200079
Hospital Revenue Code	329
Min. Negotiated Rate	$63.44
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$146.40
Rate for Payer: Aetna Medicare Advantage	$146.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.44
Rate for Payer: Cigna Commercial	$244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.44
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CT PELVIS W/CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72193
Hospital Charge Code	2200145
Hospital Revenue Code	352
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT PELVIS W/CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72193
Hospital Charge Code	2200145
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT PELVIS W & W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72194
Hospital Charge Code	2200160
Hospital Revenue Code	352
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT PELVIS W & W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72194
Hospital Charge Code	2200160
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT PERC ABCESS DRAIN LIVER

Facility

$9,500.00

Service Code	HCPCS 49405
Hospital Charge Code	2200467
Hospital Revenue Code	361
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CT PERC ABCESS DRAIN LIVER

Facility

$9,500.00

Service Code	HCPCS 49405
Hospital Charge Code	2200467
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT PERC ABSCESS DRAIN EMPYEMA

Facility

$2,422.65

Service Code	HCPCS 32551
Hospital Charge Code	2200475
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

CT PERC ABSCESS DRAIN EMPYEMA

Facility

$2,422.65

Service Code	HCPCS 32551
Hospital Charge Code	2200475
Hospital Revenue Code	361
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Better Health Medicaid	$2,426.75
Rate for Payer: Aetna Commercial	$726.79
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.94
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.40
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,475.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2,426.75

CT PERC ABSCESS DR RETROPERIT

Facility

$6,139.10

Service Code	HCPCS 49406
Hospital Charge Code	2200491
Hospital Revenue Code	361
Min. Negotiated Rate	$920.87
Max. Negotiated Rate	$920.87
Rate for Payer: Qualcare PPO/HMO/WC	$920.87

CT PERC ABSCESS DR RETROPERIT

Facility

$6,139.10

Service Code	HCPCS 49406
Hospital Charge Code	2200491
Hospital Revenue Code	361
Min. Negotiated Rate	$798.08
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,841.73
Rate for Payer: Aetna Medicare Advantage	$1,841.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.47
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	$1,565.47
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.08
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$920.87
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CT PERC RENAL PEL DR/INJ

Facility

$3,730.45

Hospital Charge Code	2205310
Hospital Revenue Code	361
Min. Negotiated Rate	$484.96
Max. Negotiated Rate	$1,865.22
Rate for Payer: Aetna Commercial	$1,119.13
Rate for Payer: Aetna Medicare Advantage	$1,119.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$951.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$951.26
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	$951.26
Rate for Payer: Cigna Commercial	$1,865.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.96
Rate for Payer: Qualcare PPO/HMO/WC	$559.57

CT PERC RENAL PEL DR/INJ

Facility

$3,730.45

Hospital Charge Code	2205310
Hospital Revenue Code	361
Min. Negotiated Rate	$559.57
Max. Negotiated Rate	$559.57
Rate for Payer: Qualcare PPO/HMO/WC	$559.57

CT PERFUSION W/CONTRAST CBF

Facility

$9,500.00

Service Code	HCPCS 0042T
Hospital Charge Code	40430042T
Hospital Revenue Code	359
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT PERFUSION W/CONTRAST CBF

Facility

$9,500.00

Service Code	HCPCS 0042T
Hospital Charge Code	40430042T
Hospital Revenue Code	359
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT PERICARDIOTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	2205169
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

Know your out-of-pocket cost for care.

All Charges