Heights University Hospital

All Charges

Charge

Type

Setting

Price

DXTRS 25% INFNT LFSH 10ML

Facility

$15.00

Hospital Charge Code	60635636
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DXTRS 25% INFNT LFSH 10ML

Facility

$15.00

Hospital Charge Code	60635636
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

DX-UPPER GI/AIR CONTRAST W/KUB

Facility

$938.00

Service Code	HCPCS 74247
Hospital Charge Code	2007015
Hospital Revenue Code	320
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$140.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.70

DX-UPPER GI/AIR CONTRAST W/KUB

Facility

$938.00

Service Code	HCPCS 74247
Hospital Charge Code	2007015
Hospital Revenue Code	320
Min. Negotiated Rate	$121.94
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$281.40
Rate for Payer: Aetna Medicare Advantage	$281.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.19
Rate for Payer: Cigna Commercial	$469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	321075820L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	321075820L
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-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	2691925
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	2691925
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-VENO EXTREMITY-RT

Facility

$3,054.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691935
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

DX-VENO EXTREMITY-RT

Facility

$3,054.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691935
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-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411151
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	366875820L
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-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	366875820L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411151
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-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	321075822
Hospital Revenue Code	320
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	321075822
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,921.26
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,633.07
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	2690755
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$1,921.26
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,633.07
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	366875822
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$917.10
Rate for Payer: Aetna Medicare Advantage	$917.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$779.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$779.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$779.53
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.41
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.55
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	2690755
Hospital Revenue Code	320
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	366875822
Hospital Revenue Code	320
Min. Negotiated Rate	$458.55
Max. Negotiated Rate	$458.55
Rate for Payer: Qualcare PPO/HMO/WC	$458.55

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	7411709
Hospital Revenue Code	320
Min. Negotiated Rate	$458.55
Max. Negotiated Rate	$458.55
Rate for Payer: Qualcare PPO/HMO/WC	$458.55

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	7411709
Hospital Revenue Code	320
Min. Negotiated Rate	$147.73
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$917.10
Rate for Payer: Aetna Medicare Advantage	$917.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$779.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$779.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$779.53
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.41
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.55
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691930
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-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	321075820R
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-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	321075820R
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