Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX-HEPATIC VENO W/HEMO EV

Facility

$3,431.00

Hospital Charge Code	2009100
Hospital Revenue Code	320
Min. Negotiated Rate	$514.65
Max. Negotiated Rate	$514.65
Rate for Payer: Qualcare PPO/HMO/WC	$514.65

DX-HIP 1 VIEW-RT

Facility

$267.00

Hospital Charge Code	2008015
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX-HIP 1 VIEW-RT

Facility

$267.00

Hospital Charge Code	2008015
Hospital Revenue Code	320
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.71
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX HIP O.R. RT

Facility

$585.00

Hospital Charge Code	2011025
Hospital Revenue Code	320
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

DX HIP O.R. RT

Facility

$585.00

Hospital Charge Code	2011025
Hospital Revenue Code	320
Min. Negotiated Rate	$76.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$175.50
Rate for Payer: Aetna Medicare Advantage	$175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.18
Rate for Payer: Cigna Commercial	$292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.05
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	321075756L
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-LT

Facility

$3,054.00

Service Code	HCPCS 75756LT
Hospital Charge Code	7412010
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	2691905
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-LT

Facility

$3,054.00

Service Code	HCPCS 75756LT
Hospital Charge Code	7412010
Hospital Revenue Code	320
Min. Negotiated Rate	$397.02
Max. Negotiated Rate	$1,527.00
Rate for Payer: Aetna Commercial	$916.20
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	321075756L
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	2691905
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	321075756R
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-RT

Facility

$3,054.00

Service Code	HCPCS 75756RT
Hospital Charge Code	7412011
Hospital Revenue Code	320
Min. Negotiated Rate	$397.02
Max. Negotiated Rate	$1,527.00
Rate for Payer: Aetna Commercial	$916.20
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-RT

Facility

$3,054.00

Service Code	HCPCS 75756RT
Hospital Charge Code	7412011
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	321075756R
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	2691910
Hospital Revenue Code	320
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	2691910
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX KNEE 3 VWS

Facility

$5,100.00

Service Code	HCPCS 73562
Hospital Charge Code	2011530
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX KNEE 3 VWS

Facility

$5,100.00

Service Code	HCPCS 73562
Hospital Charge Code	2011530
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX- KNEE ARTHROSCOPY

Facility

$25,603.80

Service Code	HCPCS 29870
Hospital Charge Code	16000921
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$7,681.14
Rate for Payer: Aetna Medicare Advantage	$7,681.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,528.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,528.97
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	$6,528.97
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,328.49
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

DX- KNEE ARTHROSCOPY

Facility

$25,603.80

Service Code	HCPCS 29870
Hospital Charge Code	16000921
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

DX KNOTLESS FIBERTAK INSTAB IM

Facility

$9,012.50

Service Code	HCPCS C1765
Hospital Charge Code	270703517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.88
Max. Negotiated Rate	$2,181.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,351.88

DX KNOTLESS FIBERTAK INSTAB IM

Facility

$9,012.50

Service Code	HCPCS C1765
Hospital Charge Code	270703517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.88
Max. Negotiated Rate	$4,506.25
Rate for Payer: Aetna Commercial	$2,703.75
Rate for Payer: Aetna Medicare Advantage	$2,703.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,298.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,298.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,802.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,298.19
Rate for Payer: Cigna Commercial	$4,506.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,351.88

DX LARYNGOSCOPY EXCL NB

Facility

$9,976.00

Service Code	HCPCS 31525
Hospital Charge Code	1600000452
Hospital Revenue Code	360
Min. Negotiated Rate	$1,296.88
Max. Negotiated Rate	$4,594.28
Rate for Payer: Aetna Better Health Medicaid	$4,504.20
Rate for Payer: Aetna Commercial	$2,992.80
Rate for Payer: Aetna Medicare Advantage	$2,992.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.88
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	$2,543.88
Rate for Payer: Cigna Commercial	$4,238.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,296.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,594.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4,504.20

DX LARYNGOSCOPY EXCL NB

Facility

$9,976.00

Service Code	HCPCS 31525
Hospital Charge Code	1600000452
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.40
Max. Negotiated Rate	$1,496.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40

Know your out-of-pocket cost for care.

All Charges