Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT RECONSTRUCTION 3D

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200426
Hospital Revenue Code	359
Min. Negotiated Rate	$28.74
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$358.33
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$28.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT RECONSTRUCTION 3D

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200426
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RECONSTRUCTION COR.SAG OBL

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200418
Hospital Revenue Code	359
Min. Negotiated Rate	$28.74
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$358.33
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$28.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT RECONSTRUCTION COR.SAG OBL

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200418
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RECONSTRUCTION MULTIPLANNAR

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200434
Hospital Revenue Code	359
Min. Negotiated Rate	$28.74
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$358.33
Rate for Payer: Aetna Medicare Advantage	$358.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.58
Rate for Payer: Cigna Commercial	$28.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.17
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT RECONSTRUCTION MULTIPLANNAR

Facility

$1,194.45

Service Code	HCPCS 76376
Hospital Charge Code	2200434
Hospital Revenue Code	359
Min. Negotiated Rate	$179.17
Max. Negotiated Rate	$179.17
Rate for Payer: Qualcare PPO/HMO/WC	$179.17

CT RENAL CYST ASPIRATION BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2250448
Hospital Revenue Code	361
Min. Negotiated Rate	$918.43
Max. Negotiated Rate	$3,532.43
Rate for Payer: Aetna Commercial	$2,119.45
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
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	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$918.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

CT RENAL CYST ASPIRATION BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	2250448
Hospital Revenue Code	361
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

CT RENAL CYST ASPIRATION LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2250449
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2250449
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION (PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2205185
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION (PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2205185
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

CT RENAL CYST ASPIRATION RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2250450
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT RENAL CYST ASPIRATION RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2250450
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

CT SCAN FOR THEARPY GUIDE-PC

Facility

$226.75

Service Code	HCPCS 7701426
Hospital Charge Code	85000010
Hospital Revenue Code	350
Min. Negotiated Rate	$29.48
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$68.03
Rate for Payer: Aetna Medicare Advantage	$68.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.82
Rate for Payer: Cigna Commercial	$113.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.48
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.01
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SCAN FOR THEARPY GUIDE-PC

Facility

$226.75

Service Code	HCPCS 7701426
Hospital Charge Code	85000010
Hospital Revenue Code	350
Min. Negotiated Rate	$34.01
Max. Negotiated Rate	$34.01
Rate for Payer: Qualcare PPO/HMO/WC	$34.01

CT SCAN FOR THEARPY GUIDE-TC

Facility

$603.25

Service Code	HCPCS 77014TC
Hospital Charge Code	85000005
Hospital Revenue Code	350
Min. Negotiated Rate	$78.42
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$180.97
Rate for Payer: Aetna Medicare Advantage	$180.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.83
Rate for Payer: Cigna Commercial	$301.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.42
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.49
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SCAN FOR THEARPY GUIDE-TC

Facility

$603.25

Service Code	HCPCS 77014TC
Hospital Charge Code	85000005
Hospital Revenue Code	350
Min. Negotiated Rate	$90.49
Max. Negotiated Rate	$90.49
Rate for Payer: Qualcare PPO/HMO/WC	$90.49

CT SCAN FOR THERAPY GUIDE-GL

Facility

$830.05

Service Code	HCPCS 77014
Hospital Charge Code	85000001
Hospital Revenue Code	350
Min. Negotiated Rate	$124.51
Max. Negotiated Rate	$124.51
Rate for Payer: Qualcare PPO/HMO/WC	$124.51

CT SCAN FOR THERAPY GUIDE-GL

Facility

$830.05

Service Code	HCPCS 77014
Hospital Charge Code	85000001
Hospital Revenue Code	350
Min. Negotiated Rate	$107.91
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$249.01
Rate for Payer: Aetna Medicare Advantage	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.66
Rate for Payer: Cigna Commercial	$415.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.91
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.51
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SCAN - MISCELLANEOUS

Facility

$643.00

Service Code	HCPCS 76499
Hospital Charge Code	2208025
Hospital Revenue Code	320
Min. Negotiated Rate	$83.59
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$192.90
Rate for Payer: Aetna Medicare Advantage	$192.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.59
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CT SCAN - MISCELLANEOUS

Facility

$643.00

Service Code	HCPCS 76499
Hospital Charge Code	2208025
Hospital Revenue Code	320
Min. Negotiated Rate	$96.45
Max. Negotiated Rate	$96.45
Rate for Payer: Qualcare PPO/HMO/WC	$96.45

CT SCANOGRAM

Facility

$1,219.00

Hospital Charge Code	2209005
Hospital Revenue Code	320
Min. Negotiated Rate	$158.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$365.70
Rate for Payer: Aetna Medicare Advantage	$365.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.85
Rate for Payer: Cigna Commercial	$609.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CT SCANOGRAM

Facility

$1,219.00

Hospital Charge Code	2209005
Hospital Revenue Code	320
Min. Negotiated Rate	$182.85
Max. Negotiated Rate	$182.85
Rate for Payer: Qualcare PPO/HMO/WC	$182.85

CT SELLA

Facility

$5,288.50

Service Code	HCPCS 70482
Hospital Charge Code	2205483
Hospital Revenue Code	351
Min. Negotiated Rate	$793.27
Max. Negotiated Rate	$793.27
Rate for Payer: Qualcare PPO/HMO/WC	$793.27

Know your out-of-pocket cost for care.

All Charges