Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412357421
Hospital Revenue Code	361
Min. Negotiated Rate	$490.18
Max. Negotiated Rate	$490.18
Rate for Payer: Qualcare PPO/HMO/WC	$490.18

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412367421
Hospital Revenue Code	361
Min. Negotiated Rate	$490.18
Max. Negotiated Rate	$490.18
Rate for Payer: Qualcare PPO/HMO/WC	$490.18

EXAM OF VAGINA W/SCOPE

Facility

$1,791.15

Service Code	HCPCS 57420
Hospital Charge Code	1600000594
Hospital Revenue Code	360
Min. Negotiated Rate	$232.85
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$537.35
Rate for Payer: Aetna Medicare Advantage	$537.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$456.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$456.74
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	$456.74
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$268.67
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

EXAM OF VAGINA W/SCOPE

Facility

$1,791.15

Service Code	HCPCS 57420
Hospital Charge Code	1600000594
Hospital Revenue Code	360
Min. Negotiated Rate	$268.67
Max. Negotiated Rate	$268.67
Rate for Payer: Qualcare PPO/HMO/WC	$268.67

EXAM/SELECT ARCHIVAL TISSUE

Facility

$66.00

Service Code	HCPCS 88363
Hospital Charge Code	38477059
Hospital Revenue Code	312
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

EXAM/SELECT ARCHIVAL TISSUE

Facility

$66.00

Service Code	HCPCS 88363
Hospital Charge Code	38477059
Hospital Revenue Code	312
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$8.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$114.00

EX ARM/ELBOW TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 24076
Hospital Charge Code	16000613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,770.02
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,084.65
Rate for Payer: Aetna Medicare Advantage	$4,084.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.95
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	$3,471.95
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EX ARM/ELBOW TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 24076
Hospital Charge Code	16000613
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EX ARM/ELBOW TUM DEEP 5 CM/>

Facility

$11,141.64

Service Code	HCPCS 24073
Hospital Charge Code	16000391
Hospital Revenue Code	360
Min. Negotiated Rate	$1,671.25
Max. Negotiated Rate	$1,671.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25

EX ARM/ELBOW TUM DEEP 5 CM/>

Facility

$11,141.64

Service Code	HCPCS 24073
Hospital Charge Code	16000391
Hospital Revenue Code	360
Min. Negotiated Rate	$1,448.41
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$3,342.49
Rate for Payer: Aetna Medicare Advantage	$3,342.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,841.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,841.12
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	$2,841.12
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.41
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC 1' WST GANGLION RT

Facility

$23,750.00

Service Code	HCPCS 25111
Hospital Charge Code	16000229
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$7,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,056.25
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	$6,056.25
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,087.50
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC 1' WST GANGLION RT

Facility

$23,750.00

Service Code	HCPCS 25111
Hospital Charge Code	16000229
Hospital Revenue Code	360
Min. Negotiated Rate	$3,562.50
Max. Negotiated Rate	$3,562.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50

EXC ABD LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 22902
Hospital Charge Code	16000499
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC ABD LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 22902
Hospital Charge Code	16000499
Hospital Revenue Code	360
Min. Negotiated Rate	$1,770.02
Max. Negotiated Rate	$4,084.65
Rate for Payer: Aetna Commercial	$4,084.65
Rate for Payer: Aetna Medicare Advantage	$4,084.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.95
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	$3,471.95
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC ABD LES SC > 3 CM

Facility

$23,455.00

Service Code	HCPCS 22903
Hospital Charge Code	16000254
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,036.50
Rate for Payer: Aetna Commercial	$7,036.50
Rate for Payer: Aetna Medicare Advantage	$7,036.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,981.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,981.02
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	$5,981.02
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,049.15
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,518.25
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC ABD LES SC > 3 CM

Facility

$23,455.00

Service Code	HCPCS 22903
Hospital Charge Code	16000254
Hospital Revenue Code	360
Min. Negotiated Rate	$3,518.25
Max. Negotiated Rate	$3,518.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,518.25

EXC ABDL TUM DEEP < 5 CM

Facility

$20,625.50

Service Code	HCPCS 22900
Hospital Charge Code	16000811
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

EXC ABDL TUM DEEP < 5 CM

Facility

$20,625.50

Service Code	HCPCS 22900
Hospital Charge Code	16000811
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$6,187.65
Rate for Payer: Aetna Medicare Advantage	$6,187.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,259.50
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	$5,259.50
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,681.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC ABDL TUM DEEP 5 CM/>

Facility

$21,488.80

Service Code	HCPCS 22901
Hospital Charge Code	16000470
Hospital Revenue Code	360
Min. Negotiated Rate	$3,223.32
Max. Negotiated Rate	$3,223.32
Rate for Payer: Qualcare PPO/HMO/WC	$3,223.32

EXC ABDL TUM DEEP 5 CM/>

Facility

$21,488.80

Service Code	HCPCS 22901
Hospital Charge Code	16000470
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$6,446.64
Rate for Payer: Aetna Medicare Advantage	$6,446.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,479.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,479.64
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	$5,479.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,793.54
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,223.32
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC ABD TUM 5 CM OR LESS

Facility

$13,300.00

Service Code	HCPCS 49203
Hospital Charge Code	16000986
Hospital Revenue Code	360
Min. Negotiated Rate	$1,995.00
Max. Negotiated Rate	$1,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,995.00

EXC ABD TUM 5 CM OR LESS

Facility

$13,300.00

Service Code	HCPCS 49203
Hospital Charge Code	16000986
Hospital Revenue Code	360
Min. Negotiated Rate	$1,729.00
Max. Negotiated Rate	$6,650.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,391.50
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	$3,391.50
Rate for Payer: Cigna Commercial	$6,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.00
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,995.00
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXCALI BUR

Facility

$295.00

Hospital Charge Code	270682451
Hospital Revenue Code	272
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

EXCALI BUR

Facility

$295.00

Hospital Charge Code	270682451
Hospital Revenue Code	272
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$88.50
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$147.50
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Commercial	$147.50

EXCALIBUR CURVED HL 4.2 MMX19C

Facility

$330.00

Hospital Charge Code	270682875
Hospital Revenue Code	272
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Commercial	$165.00

Know your out-of-pocket cost for care.

All Charges