Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-LUMBAR PUNC FOR DX

Facility

$3,506.55

Service Code	HCPCS 62270
Hospital Charge Code	321062270
Hospital Revenue Code	361
Min. Negotiated Rate	$525.98
Max. Negotiated Rate	$525.98
Rate for Payer: Qualcare PPO/HMO/WC	$525.98

IR LYMPHANGIOGRAM ABDMNAL LEFT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600093
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM ABDMNAL LEFT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600093
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRAM ABDMNAL RGHT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600094
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRAM ABDMNAL RGHT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600094
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM ABDMN BLTRAL

Facility

$1,224.75

Service Code	HCPCS 75807
Hospital Charge Code	2600092
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM ABDMN BLTRAL

Facility

$1,224.75

Service Code	HCPCS 75807
Hospital Charge Code	2600092
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRAM PELVIC BLTRL

Facility

$1,224.75

Service Code	HCPCS 75807
Hospital Charge Code	2600098
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM PELVIC BLTRL

Facility

$1,224.75

Service Code	HCPCS 75807
Hospital Charge Code	2600098
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRAM PELVIC LEFT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600099
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRAM PELVIC LEFT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600099
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM PELVIC RIGHT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600100
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRAM PELVIC RIGHT

Facility

$1,224.75

Service Code	HCPCS 75805
Hospital Charge Code	2600100
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM LWR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600095
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM LWR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600095
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM LWR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600096
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM LWR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600096
Hospital Revenue Code	320
Min. Negotiated Rate	$135.76
Max. Negotiated Rate	$1,493.86
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM LWR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600097
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM LWR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600097
Hospital Revenue Code	320
Min. Negotiated Rate	$135.76
Max. Negotiated Rate	$1,493.86
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM UPR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600101
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM UPR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600101
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM UPR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600102
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM UPR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600102
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM UPR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600103
Hospital Revenue Code	320
Min. Negotiated Rate	$135.76
Max. Negotiated Rate	$1,493.86
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR LYMPHANGIOGRM UPR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600103
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

Know your out-of-pocket cost for care.

All Charges