Heights University Hospital

All Charges

Charge

Type

Setting

Price

KYPHOPLASTY KIT G21

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695718
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$10,625.00
Rate for Payer: Aetna Commercial	$6,375.00
Rate for Payer: Aetna Medicare Advantage	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,418.75
Rate for Payer: Cigna Commercial	$10,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

KYPHX LATITUDE CURETTE A11B

Facility

$810.70

Hospital Charge Code	270633991
Hospital Revenue Code	272
Min. Negotiated Rate	$105.39
Max. Negotiated Rate	$405.35
Rate for Payer: Aetna Commercial	$243.21
Rate for Payer: Aetna Medicare Advantage	$243.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.73
Rate for Payer: Cigna Commercial	$405.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.39
Rate for Payer: Oxford Commercial	$405.35
Rate for Payer: Qualcare PPO/HMO/WC	$121.61
Rate for Payer: UnitedHealthcare Commercial	$405.35

KYPHX LATITUDE CURETTE A11B

Facility

$810.70

Hospital Charge Code	270633991
Hospital Revenue Code	272
Min. Negotiated Rate	$121.61
Max. Negotiated Rate	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$121.61

KYTRIL SYRINGE 0.1 MG/0.1 ML

Facility

$96.85

Hospital Charge Code	60629358
Hospital Revenue Code	636
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$48.42
Rate for Payer: Aetna Commercial	$29.05
Rate for Payer: Aetna Medicare Advantage	$29.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.70
Rate for Payer: Cigna Commercial	$48.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.44
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

KYTRIL SYRINGE 0.1 MG/0.1 ML

Facility

$96.85

Hospital Charge Code	60629358
Hospital Revenue Code	636
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$23.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.44
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

L-0-SLIDE REVIEW

Facility

$70.15

Service Code	HCPCS 88321
Hospital Charge Code	3035064
Hospital Revenue Code	319
Min. Negotiated Rate	$10.52
Max. Negotiated Rate	$10.52
Rate for Payer: Qualcare PPO/HMO/WC	$10.52

L-0-SLIDE REVIEW

Facility

$70.15

Service Code	HCPCS 88321
Hospital Charge Code	3035064
Hospital Revenue Code	319
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$114.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: Aetna Commercial	$21.05
Rate for Payer: Aetna Medicare Advantage	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.89
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$36.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.52

L-0 SLIDE REVIEW NO PREPOS

Facility

$335.00

Service Code	HCPCS 88325
Hospital Charge Code	3035064A
Hospital Revenue Code	319
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$50.25
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

L-0 SLIDE REVIEW NO PREPOS

Facility

$335.00

Service Code	HCPCS 88325
Hospital Charge Code	3035064A
Hospital Revenue Code	319
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$100.50
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$60.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.25
Rate for Payer: UnitedHealthcare Commercial	$114.00

L10-NERVE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035061
Hospital Revenue Code	310
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

L10-NERVE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035061
Hospital Revenue Code	310
Min. Negotiated Rate	$26.94
Max. Negotiated Rate	$125.27
Rate for Payer: Aetna Commercial	$62.17
Rate for Payer: Aetna Medicare Advantage	$62.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$125.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

L7-KIDNEY BIOPSY ELECT MICRO

Facility

$1,188.85

Service Code	HCPCS 88348
Hospital Charge Code	3035063
Hospital Revenue Code	310
Min. Negotiated Rate	$178.33
Max. Negotiated Rate	$178.33
Rate for Payer: Qualcare PPO/HMO/WC	$178.33

L7-KIDNEY BIOPSY ELECT MICRO

Facility

$1,188.85

Service Code	HCPCS 88348
Hospital Charge Code	3035063
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$356.65
Rate for Payer: Aetna Medicare Advantage	$356.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.16
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$274.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$178.33
Rate for Payer: UnitedHealthcare Commercial	$114.00

L8-KIDNEY BIOPSY IMMUNO MICRO

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3035062A
Hospital Revenue Code	312
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

L8-KIDNEY BIOPSY IMMUNO MICRO

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3035062
Hospital Revenue Code	312
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$78.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

L8-KIDNEY BIOPSY IMMUNO MICRO

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3035062A
Hospital Revenue Code	312
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$78.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

L8-KIDNEY BIOPSY IMMUNO MICRO

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3035062
Hospital Revenue Code	312
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

L9 - MUSCLE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035060
Hospital Revenue Code	310
Min. Negotiated Rate	$26.94
Max. Negotiated Rate	$125.27
Rate for Payer: Aetna Commercial	$62.17
Rate for Payer: Aetna Medicare Advantage	$62.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$125.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

L9 - MUSCLE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035060
Hospital Revenue Code	310
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,396.79
Rate for Payer: Aetna Commercial	$6,459.08
Rate for Payer: Aetna Medicare Advantage	$6,459.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,490.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,490.22
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	$5,490.22
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,798.94
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,229.54
Max. Negotiated Rate	$3,229.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54

LABEL 30-UP HOLE PUNCHING

Facility

$73.95

Hospital Charge Code	270650407
Hospital Revenue Code	270
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$36.98
Rate for Payer: Aetna Commercial	$22.18
Rate for Payer: Aetna Medicare Advantage	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.86
Rate for Payer: Cigna Commercial	$36.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.61
Rate for Payer: Oxford Commercial	$36.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.09
Rate for Payer: UnitedHealthcare Commercial	$36.98

LABEL 30-UP HOLE PUNCHING

Facility

$73.95

Hospital Charge Code	270650407
Hospital Revenue Code	270
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$11.09
Rate for Payer: Qualcare PPO/HMO/WC	$11.09

LABEL 4X1-55/16 WHT/RED PERM

Facility

$53.25

Hospital Charge Code	270657889
Hospital Revenue Code	270
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$7.99

LABEL 4X1-55/16 WHT/RED PERM

Facility

$53.25

Hospital Charge Code	270657889
Hospital Revenue Code	270
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$26.62
Rate for Payer: Aetna Commercial	$15.97
Rate for Payer: Aetna Medicare Advantage	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.58
Rate for Payer: Cigna Commercial	$26.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.92
Rate for Payer: Oxford Commercial	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.99
Rate for Payer: UnitedHealthcare Commercial	$26.62

Know your out-of-pocket cost for care.

All Charges