Heights University Hospital

All Charges

Charge

Type

Setting

Price

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	7411813
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	7411813
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	2690575
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	2690575
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	7411946
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	2691480
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	7411946
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	2691480
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	2691485
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	7411947
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	2691485
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	7411947
Hospital Revenue Code	761
Min. Negotiated Rate	$90.61
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$348.50
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$348.50

IR-LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2009145
Hospital Revenue Code	361
Min. Negotiated Rate	$1,209.39
Max. Negotiated Rate	$4,651.50
Rate for Payer: Aetna Commercial	$2,790.90
Rate for Payer: Aetna Medicare Advantage	$2,790.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,372.26
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	$2,372.26
Rate for Payer: Cigna Commercial	$4,651.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

IR-LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2009145
Hospital Revenue Code	361
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$1,395.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

IR-LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2009200
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

IR-LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2009200
Hospital Revenue Code	361
Min. Negotiated Rate	$806.26
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$1,860.60
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
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	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.26
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

IR-LYMPH NODE-SUPER-RT

Facility

$6,202.00

Service Code	HCPCS 38505RT
Hospital Charge Code	2009205
Hospital Revenue Code	361
Min. Negotiated Rate	$806.26
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$1,860.60
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
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	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.26
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

IR-LYMPH NODE-SUPER-RT

Facility

$6,202.00

Service Code	HCPCS 38505RT
Hospital Charge Code	2009205
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

IR-MEASUR KIDNEY PRESS-BI

Facility

$316.00

Service Code	HCPCS 5039650
Hospital Charge Code	7411825
Hospital Revenue Code	361
Min. Negotiated Rate	$47.40
Max. Negotiated Rate	$47.40
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-BI

Facility

$316.00

Service Code	HCPCS 5039650
Hospital Charge Code	7411825
Hospital Revenue Code	361
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$94.80
Rate for Payer: Aetna Medicare Advantage	$94.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.58
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	$80.58
Rate for Payer: Cigna Commercial	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-BI

Facility

$316.00

Service Code	HCPCS 5039650
Hospital Charge Code	2690655
Hospital Revenue Code	361
Min. Negotiated Rate	$47.40
Max. Negotiated Rate	$47.40
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-BI

Facility

$316.00

Service Code	HCPCS 5039650
Hospital Charge Code	2690655
Hospital Revenue Code	361
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$94.80
Rate for Payer: Aetna Medicare Advantage	$94.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.58
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	$80.58
Rate for Payer: Cigna Commercial	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-LT

Facility

$316.00

Service Code	HCPCS 50396LT
Hospital Charge Code	7411970
Hospital Revenue Code	361
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$94.80
Rate for Payer: Aetna Medicare Advantage	$94.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.58
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	$80.58
Rate for Payer: Cigna Commercial	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-LT

Facility

$316.00

Service Code	HCPCS 50396LT
Hospital Charge Code	2691640
Hospital Revenue Code	361
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$94.80
Rate for Payer: Aetna Medicare Advantage	$94.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.58
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	$80.58
Rate for Payer: Cigna Commercial	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

IR-MEASUR KIDNEY PRESS-LT

Facility

$316.00

Service Code	HCPCS 50396LT
Hospital Charge Code	2691640
Hospital Revenue Code	361
Min. Negotiated Rate	$47.40
Max. Negotiated Rate	$47.40
Rate for Payer: Qualcare PPO/HMO/WC	$47.40

Know your out-of-pocket cost for care.

All Charges