Heights University Hospital

All Charges

Charge

Type

Setting

Price

INJECT SACROILIAC JOINT

Facility

$3,087.00

Service Code	HCPCS G0259
Hospital Charge Code	3215G0259
Hospital Revenue Code	361
Min. Negotiated Rate	$401.31
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$926.10
Rate for Payer: Aetna Medicare Advantage	$926.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.18
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	$787.18
Rate for Payer: Cigna Commercial	$1,543.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.05
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJECT SACROILIAC JOINT

Facility

$3,087.00

Service Code	HCPCS G0259
Hospital Charge Code	3215G0259
Hospital Revenue Code	361
Min. Negotiated Rate	$463.05
Max. Negotiated Rate	$463.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.05

INJECT SKIN LESIONS </= 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	412311900
Hospital Revenue Code	361
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

INJECT SKIN LESIONS </= 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	412311900
Hospital Revenue Code	361
Min. Negotiated Rate	$134.32
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$309.98
Rate for Payer: Aetna Medicare Advantage	$309.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.48
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	$263.48
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.32
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJECT SKIN LESIONS >7

Facility

$1,033.25

Service Code	HCPCS 11901
Hospital Charge Code	412311901
Hospital Revenue Code	361
Min. Negotiated Rate	$134.32
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$309.98
Rate for Payer: Aetna Medicare Advantage	$309.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.48
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	$263.48
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.32
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJECT SKIN LESIONS >7

Facility

$1,033.25

Service Code	HCPCS 11901
Hospital Charge Code	412311901
Hospital Revenue Code	361
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

INJECT SPINE C/T

Facility

$3,466.32

Service Code	HCPCS 62320
Hospital Charge Code	16000767
Hospital Revenue Code	360
Min. Negotiated Rate	$450.62
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,039.90
Rate for Payer: Aetna Medicare Advantage	$1,039.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$883.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$883.91
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	$883.91
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.62
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$519.95
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

INJECT SPINE C/T

Facility

$3,466.32

Service Code	HCPCS 62320
Hospital Charge Code	16000767
Hospital Revenue Code	360
Min. Negotiated Rate	$519.95
Max. Negotiated Rate	$519.95
Rate for Payer: Qualcare PPO/HMO/WC	$519.95

INJECT SPINE DISK X-RAY LUMBAR

Facility

$6,095.00

Service Code	HCPCS 62290
Hospital Charge Code	16000523
Hospital Revenue Code	360
Min. Negotiated Rate	$155.15
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,828.50
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
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	$1,554.22
Rate for Payer: Cigna Commercial	$155.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$792.35
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJECT SPINE DISK X-RAY LUMBAR

Facility

$6,095.00

Service Code	HCPCS 62290
Hospital Charge Code	16000523
Hospital Revenue Code	360
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

INJECT TGGER POINTS =/>3

Facility

$4,088.04

Service Code	HCPCS 20553
Hospital Charge Code	1600000442
Hospital Revenue Code	360
Min. Negotiated Rate	$613.21
Max. Negotiated Rate	$613.21
Rate for Payer: Qualcare PPO/HMO/WC	$613.21

INJECT TGGER POINTS =/>3

Facility

$4,088.04

Service Code	HCPCS 20553
Hospital Charge Code	1600000442
Hospital Revenue Code	360
Min. Negotiated Rate	$531.45
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$1,226.41
Rate for Payer: Aetna Medicare Advantage	$1,226.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.45
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	$1,042.45
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.45
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.21
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ ERCP

Facility

$10,268.63

Hospital Charge Code	2011500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,540.29
Max. Negotiated Rate	$1,540.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.29

INJ ERCP

Facility

$10,268.63

Hospital Charge Code	2011500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,334.92
Max. Negotiated Rate	$5,134.31
Rate for Payer: Aetna Commercial	$3,080.59
Rate for Payer: Aetna Medicare Advantage	$3,080.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.50
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	$2,618.50
Rate for Payer: Cigna Commercial	$5,134.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,334.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.29

INJ ERGONOVINE MALEATE 0.2ML

Facility

$34.60

Hospital Charge Code	6012512
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$8.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

INJ ERGONOVINE MALEATE 0.2ML

Facility

$34.60

Hospital Charge Code	6012512
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

INJ ESTROGEN SUB CNJGTD 5MG/ML

Facility

$234.25

Hospital Charge Code	6002323
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$70.28
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

INJ ESTROGEN SUB CNJGTD 5MG/ML

Facility

$234.25

Hospital Charge Code	6002323
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$56.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

INJETAK ADJUSTABLE NEEDLE 70CM

Facility

$1,196.00

Hospital Charge Code	270702238
Hospital Revenue Code	279
Min. Negotiated Rate	$155.48
Max. Negotiated Rate	$598.00
Rate for Payer: Aetna Commercial	$358.80
Rate for Payer: Aetna Medicare Advantage	$358.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.98
Rate for Payer: Cigna Commercial	$598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.48
Rate for Payer: Oxford Commercial	$598.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.40
Rate for Payer: UnitedHealthcare Commercial	$598.00

INJETAK ADJUSTABLE NEEDLE 70CM

Facility

$1,196.00

Hospital Charge Code	270702238
Hospital Revenue Code	279
Min. Negotiated Rate	$179.40
Max. Negotiated Rate	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$179.40

INJ FORAMEN EPIDURAL ADD-ON

Facility

$3,152.73

Service Code	HCPCS 64484
Hospital Charge Code	1600000459
Hospital Revenue Code	360
Min. Negotiated Rate	$472.91
Max. Negotiated Rate	$472.91
Rate for Payer: Qualcare PPO/HMO/WC	$472.91

INJ FORAMEN EPIDURAL ADD-ON

Facility

$3,152.73

Service Code	HCPCS 64484
Hospital Charge Code	1600000459
Hospital Revenue Code	360
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$1,864.00
Rate for Payer: Cigna Commercial	$47.34
Rate for Payer: Aetna Commercial	$945.82
Rate for Payer: Aetna Medicare Advantage	$945.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.95
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	$803.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.91
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$1,034.38
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Better Health Medicaid	$2,266.41
Rate for Payer: Aetna Commercial	$2,387.04
Rate for Payer: Aetna Medicare Advantage	$2,387.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,028.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,028.98
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	$2,028.98
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.38
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$2,575.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$898.47
Rate for Payer: Aetna Medicare Advantage	$898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.70
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	$763.70
Rate for Payer: Cigna Commercial	$40.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.24
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges