Heights University Hospital

All Charges

Charge

Type

Setting

Price

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHOTHIOPHATE OPH SOL 0.03%

Facility

$240.85

Hospital Charge Code	60628055
Hospital Revenue Code	250
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$72.25
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.31
Rate for Payer: Oxford Commercial	$120.42
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Commercial	$120.42

ECHOTHIOPHATE OPH SOL 0.03%

Facility

$240.85

Hospital Charge Code	60628055
Hospital Revenue Code	250
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$36.13
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

ECHOTHIOPHATE OPH SOL 0.25%

Facility

$320.85

Hospital Charge Code	60628056
Hospital Revenue Code	250
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

ECHOTHIOPHATE OPH SOL 0.25%

Facility

$320.85

Hospital Charge Code	60628056
Hospital Revenue Code	250
Min. Negotiated Rate	$41.71
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$96.25
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.71
Rate for Payer: Oxford Commercial	$160.43
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Commercial	$160.43

ECHOTHIOP IOD OPH SOL .06% 5ML

Facility

$31.40

Hospital Charge Code	6002117
Hospital Revenue Code	252
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$9.42
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Oxford Commercial	$15.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$15.70

ECHOTHIOP IOD OPH SOL .06% 5ML

Facility

$31.40

Hospital Charge Code	6002117
Hospital Revenue Code	252
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

ECHOTHIOP IOD OPH SOL .125% 5M

Facility

$44.00

Hospital Charge Code	6002125
Hospital Revenue Code	252
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

ECHOTHIOP IOD OPH SOL .125% 5M

Facility

$44.00

Hospital Charge Code	6002125
Hospital Revenue Code	252
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

ECHOTHIOP IOD OPH SOL .25% 5ML

Facility

$203.55

Hospital Charge Code	6002133
Hospital Revenue Code	252
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$61.06
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.46
Rate for Payer: Oxford Commercial	$101.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$101.78

ECHOTHIOP IOD OPH SOL .25% 5ML

Facility

$203.55

Hospital Charge Code	6002133
Hospital Revenue Code	252
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

ECHO TRANSESOPHAGEAL TEE

Facility

$7,257.67

Service Code	HCPCS 93312
Hospital Charge Code	94053120
Hospital Revenue Code	483
Min. Negotiated Rate	$1,088.65
Max. Negotiated Rate	$1,088.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.65

ECHO TRANSESOPHAGEAL TEE

Facility

$7,257.67

Service Code	HCPCS 93312
Hospital Charge Code	94053120
Hospital Revenue Code	483
Min. Negotiated Rate	$650.90
Max. Negotiated Rate	$2,177.30
Rate for Payer: Aetna Commercial	$2,177.30
Rate for Payer: Aetna Medicare Advantage	$2,177.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,850.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,850.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,850.71
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.50
Rate for Payer: Oxford Commercial	$1,514.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.65
Rate for Payer: UnitedHealthcare Commercial	$1,719.00

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$650.90
Max. Negotiated Rate	$1,770.00
Rate for Payer: Aetna Commercial	$1,770.00
Rate for Payer: Aetna Medicare Advantage	$1,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,504.50
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.00
Rate for Payer: Oxford Commercial	$1,514.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$1,719.00

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038E
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges