Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX-MAMMOGRAPHY-LT

Facility

$208.00

Hospital Charge Code	2009305
Hospital Revenue Code	401
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

DX-MAMMOGRAPHY-LT

Facility

$208.00

Hospital Charge Code	2009305
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DX-MAMMOGRAPHY-RT

Facility

$208.00

Hospital Charge Code	2009310
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DX-MAMMOGRAPHY-RT

Facility

$208.00

Hospital Charge Code	2009310
Hospital Revenue Code	401
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

DX-MAMMO GUIDE NDL PLC-LT

Facility

$1,119.00

Hospital Charge Code	2009295
Hospital Revenue Code	320
Min. Negotiated Rate	$145.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$335.70
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-MAMMO GUIDE NDL PLC-LT

Facility

$1,119.00

Hospital Charge Code	2009295
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUID NDL PLCM-BI

Facility

$1,119.00

Hospital Charge Code	2009180
Hospital Revenue Code	320
Min. Negotiated Rate	$145.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$335.70
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-MAMMO GUID NDL PLCM-BI

Facility

$1,119.00

Hospital Charge Code	2009180
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUID NDL PLMT-RT

Facility

$1,119.00

Hospital Charge Code	2009300
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUID NDL PLMT-RT

Facility

$1,119.00

Hospital Charge Code	2009300
Hospital Revenue Code	320
Min. Negotiated Rate	$145.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$335.70
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX MASTOIDS LTD< 3 VWS

Facility

$267.00

Service Code	HCPCS 70120
Hospital Charge Code	2011510
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX MASTOIDS LTD< 3 VWS

Facility

$267.00

Service Code	HCPCS 70120
Hospital Charge Code	2011510
Hospital Revenue Code	320
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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) NJ Health	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$248.96
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	3668744255
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	2690710
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	2690710
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	411074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$759.00

Service Code	HCPCS 7442550
Hospital Charge Code	7411835
Hospital Revenue Code	320
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$113.85
Rate for Payer: Qualcare PPO/HMO/WC	$113.85

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	3668744255
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	321074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	321074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	411074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-BIL

Facility

$759.00

Service Code	HCPCS 7442550
Hospital Charge Code	7411835
Hospital Revenue Code	320
Min. Negotiated Rate	$98.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$227.70
Rate for Payer: Aetna Medicare Advantage	$227.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.54
Rate for Payer: Cigna Commercial	$379.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	2691760
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges