Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL III SP GROSS&MICROSCOPIC

Facility

$873.60

Service Code	HCPCS 88304TC
Hospital Charge Code	3005290
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

LEVEL III SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88304TC
Hospital Charge Code	3005291
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL III SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88304TC
Hospital Charge Code	3005291
Hospital Revenue Code	312
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL III SP GROSS&MICROSCOPIC

Facility

$873.60

Service Code	HCPCS 88304TC
Hospital Charge Code	3005290
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$436.80
Rate for Payer: Aetna Commercial	$262.08
Rate for Payer: Aetna Medicare Advantage	$262.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.77
Rate for Payer: Cigna Commercial	$436.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II SP GROSS&MICROSCOP***

Facility

$13.00

Service Code	HCPCS 8830259
Hospital Charge Code	3005285A
Hospital Revenue Code	312
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LEVEL II SP GROSS&MICROSCOP***

Facility

$13.00

Service Code	HCPCS 8830259
Hospital Charge Code	3005285A
Hospital Revenue Code	312
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005286
Hospital Revenue Code	312
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005286
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL II SP GROSS&MICROSCOPIC

Facility

$418.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005285
Hospital Revenue Code	310
Min. Negotiated Rate	$54.34
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$125.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II SP GROSS&MICROSCOPIC

Facility

$418.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005285
Hospital Revenue Code	310
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

LEVEL I SP GROSS & MICROSC***

Facility

$13.00

Service Code	HCPCS 8830059
Hospital Charge Code	3005280A
Hospital Revenue Code	312
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LEVEL I SP GROSS & MICROSC***

Facility

$13.00

Service Code	HCPCS 8830059
Hospital Charge Code	3005280A
Hospital Revenue Code	312
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL I SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88300
Hospital Charge Code	3005281
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL I SP GROSS&MICROSCOPIC

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	3005280
Hospital Revenue Code	310
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

LEVEL I SP GROSS&MICROSCOPIC

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	3005280
Hospital Revenue Code	310
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$139.50
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$9.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL I SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88300
Hospital Charge Code	3005281
Hospital Revenue Code	312
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$9.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL IV SP GROSS&MICROSCOPIC

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005294
Hospital Revenue Code	310
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SP GROSS&MICROSCOPIC

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005294
Hospital Revenue Code	310
Min. Negotiated Rate	$89.97
Max. Negotiated Rate	$346.05
Rate for Payer: Aetna Commercial	$207.63
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$346.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL IV SP GROSS&MICROSCOPIC

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064043
Hospital Revenue Code	310
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SP GROSS&MICROSCOPIC

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064043
Hospital Revenue Code	310
Min. Negotiated Rate	$39.47
Max. Negotiated Rate	$207.63
Rate for Payer: Aetna Commercial	$207.63
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$39.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005293
Hospital Revenue Code	312
Min. Negotiated Rate	$89.97
Max. Negotiated Rate	$346.05
Rate for Payer: Aetna Commercial	$207.63
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$346.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064045
Hospital Revenue Code	310
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305TC
Hospital Charge Code	3005293
Hospital Revenue Code	312
Min. Negotiated Rate	$103.81
Max. Negotiated Rate	$103.81
Rate for Payer: Qualcare PPO/HMO/WC	$103.81

LEVEL IV SURG PATHOLOGY

Facility

$692.10

Service Code	HCPCS 88305
Hospital Charge Code	94064045
Hospital Revenue Code	310
Min. Negotiated Rate	$39.47
Max. Negotiated Rate	$207.63
Rate for Payer: Aetna Commercial	$207.63
Rate for Payer: Aetna Medicare Advantage	$207.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.49
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$39.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.81
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL IV SURG PATHOLOGY***

Facility

$22.00

Service Code	HCPCS 8830559
Hospital Charge Code	3005294A
Hospital Revenue Code	312
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges