Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	321738222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	321738222
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,648.85
Rate for Payer: Aetna Medicare Advantage	$4,648.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,951.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,951.52
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	$3,951.52
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.50
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404138222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404338222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404138222
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,648.85
Rate for Payer: Aetna Medicare Advantage	$4,648.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,951.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,951.52
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	$3,951.52
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.50
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404338222
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,648.85
Rate for Payer: Aetna Medicare Advantage	$4,648.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,951.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,951.52
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	$3,951.52
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.50
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

DX-BONE SURVEY-COMPLETE

Facility

$450.00

Service Code	HCPCS 77075
Hospital Charge Code	2007040
Hospital Revenue Code	320
Min. Negotiated Rate	$52.38
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX-BONE SURVEY-COMPLETE

Facility

$450.00

Service Code	HCPCS 77075
Hospital Charge Code	2007040
Hospital Revenue Code	320
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

DX-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	7411838
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	2690735
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	7411838
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	2690735
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	2691810
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	7411998
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	2691810
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	7411998
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	2691815
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	2691815
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	7411999
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	7411999
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-BREAST OR OTH SURG SPECIMEN

Facility

$2,525.90

Service Code	HCPCS 76098
Hospital Charge Code	2007025
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$644.10
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-BREAST OR OTH SURG SPECIMEN

Facility

$2,525.90

Service Code	HCPCS 76098
Hospital Charge Code	2007025
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

DX-CHANGE ABSCESS CATH

Facility

$1,062.00

Hospital Charge Code	2009135
Hospital Revenue Code	320
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Qualcare PPO/HMO/WC	$159.30

DX-CHANGE ABSCESS CATH

Facility

$1,062.00

Hospital Charge Code	2009135
Hospital Revenue Code	320
Min. Negotiated Rate	$138.06
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$318.60
Rate for Payer: Aetna Medicare Advantage	$318.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.81
Rate for Payer: Cigna Commercial	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.06
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-CHEST SINGLE VIEW

Facility

$582.98

Hospital Charge Code	4509001
Hospital Revenue Code	324
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

Know your out-of-pocket cost for care.

All Charges