Heights University Hospital

All Charges

Charge

Type

Setting

Price

DESTROY LUMB/SAC FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64635
Hospital Charge Code	321564635
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY LUMB/SAC FACET JNT

Facility

$10,093.90

Service Code	HCPCS 64635
Hospital Charge Code	16000524
Hospital Revenue Code	360
Min. Negotiated Rate	$1,514.09
Max. Negotiated Rate	$1,514.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,514.09

DESTROY LUMB/SAC FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64635
Hospital Charge Code	321564635
Hospital Revenue Code	361
Min. Negotiated Rate	$1,401.76
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$3,234.83
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,401.76
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DESTROY,VULVA LESIONS,SIM

Facility

$33,410.80

Service Code	HCPCS 56501
Hospital Charge Code	16001003
Hospital Revenue Code	360
Min. Negotiated Rate	$708.84
Max. Negotiated Rate	$10,023.24
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$10,023.24
Rate for Payer: Aetna Medicare Advantage	$10,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,519.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,519.75
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	$8,519.75
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,343.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,011.62
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$708.84

DESTROY,VULVA LESIONS,SIM

Facility

$33,410.80

Service Code	HCPCS 56501
Hospital Charge Code	16001003
Hospital Revenue Code	360
Min. Negotiated Rate	$5,011.62
Max. Negotiated Rate	$5,011.62
Rate for Payer: Qualcare PPO/HMO/WC	$5,011.62

DESTROY VULVA LESIONS SIMPL

Facility

$745.00

Service Code	HCPCS 56501
Hospital Charge Code	83652125
Hospital Revenue Code	514
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

DESTROY VULVA LESIONS SIMPL

Facility

$745.00

Service Code	HCPCS 56501
Hospital Charge Code	83652125
Hospital Revenue Code	514
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Better Health Medicaid	$708.84
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.85
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02

DESTR PARAVERTEBRL N ADDON 50

Facility

$3,580.00

Service Code	HCPCS 64636
Hospital Charge Code	1600000432
Hospital Revenue Code	360
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,074.00
Rate for Payer: Aetna Medicare Advantage	$1,074.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.90
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	$912.90
Rate for Payer: Cigna Commercial	$54.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$537.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DESTR PARAVERTEBRL N ADDON 50

Facility

$3,580.00

Service Code	HCPCS 64636
Hospital Charge Code	1600000432
Hospital Revenue Code	360
Min. Negotiated Rate	$537.00
Max. Negotiated Rate	$537.00
Rate for Payer: Qualcare PPO/HMO/WC	$537.00

DESTR PARAVERTEBRL NERVE C/T-

Facility

$4,344.06

Service Code	HCPCS 64633
Hospital Charge Code	160000249
Hospital Revenue Code	360
Min. Negotiated Rate	$651.61
Max. Negotiated Rate	$651.61
Rate for Payer: Qualcare PPO/HMO/WC	$651.61

DESTR PARAVERTEBRL NERVE C/T-

Facility

$4,344.06

Service Code	HCPCS 64633
Hospital Charge Code	160000249
Hospital Revenue Code	360
Min. Negotiated Rate	$564.73
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$1,303.22
Rate for Payer: Aetna Medicare Advantage	$1,303.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,107.74
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	$1,107.74
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$564.73
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$651.61
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

DESTRUCT B9 LESION 1-14

Facility

$994.50

Service Code	HCPCS 17110
Hospital Charge Code	16000321
Hospital Revenue Code	360
Min. Negotiated Rate	$129.28
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$298.35
Rate for Payer: Aetna Medicare Advantage	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.60
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	$253.60
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.28
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.18
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DESTRUCT B9 LESION 1-14

Facility

$994.50

Service Code	HCPCS 17110
Hospital Charge Code	16000321
Hospital Revenue Code	360
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$149.18
Rate for Payer: Qualcare PPO/HMO/WC	$149.18

DESTRUCTION ANAL LESIONS

Facility

$1,330.15

Service Code	HCPCS 46900
Hospital Charge Code	87502935
Hospital Revenue Code	761
Min. Negotiated Rate	$199.52
Max. Negotiated Rate	$199.52
Rate for Payer: Qualcare PPO/HMO/WC	$199.52

DESTRUCTION ANAL LESIONS

Facility

$1,330.15

Service Code	HCPCS 46900
Hospital Charge Code	87502935
Hospital Revenue Code	761
Min. Negotiated Rate	$42.55
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$399.05
Rate for Payer: Aetna Medicare Advantage	$399.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$339.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$339.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$339.19
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.92
Rate for Payer: Oxford Commercial	$665.08
Rate for Payer: Qualcare PPO/HMO/WC	$199.52
Rate for Payer: UnitedHealthcare Commercial	$665.08

DESTRUCTION PENIS LESION (S)

Facility

$10,771.05

Service Code	HCPCS 54065
Hospital Charge Code	1600000336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,400.24
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$3,231.32
Rate for Payer: Aetna Medicare Advantage	$3,231.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,746.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,746.62
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	$2,746.62
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,400.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

DESTRUCTION PENIS LESION (S)

Facility

$10,771.05

Service Code	HCPCS 54065
Hospital Charge Code	1600000336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,615.66
Max. Negotiated Rate	$1,615.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66

DESTR W NEUROLYTIC,OTHER PE

Facility

$7,956.80

Service Code	HCPCS 64640
Hospital Charge Code	16000525
Hospital Revenue Code	360
Min. Negotiated Rate	$1,034.38
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$2,387.04
Rate for Payer: Aetna Medicare Advantage	$2,387.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,028.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,028.98
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	$2,028.98
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

DESTR W NEUROLYTIC,OTHER PE

Facility

$7,956.80

Service Code	HCPCS 64640
Hospital Charge Code	16000525
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

DESYREL/100MG/TAB

Facility

$12.00

Hospital Charge Code	60632804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

DESYREL/100MG/TAB

Facility

$12.00

Hospital Charge Code	60632804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

DESYREL/50MG/TAB

Facility

$7.00

Hospital Charge Code	60632803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

DESYREL/50MG/TAB

Facility

$7.00

Hospital Charge Code	60632803
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588O
Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

Know your out-of-pocket cost for care.

All Charges