Heights University Hospital

All Charges

Charge

Type

Setting

Price

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	7411705
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	7411705
Hospital Revenue Code	320
Min. Negotiated Rate	$203.64
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	2680340
Hospital Revenue Code	320
Min. Negotiated Rate	$203.64
Max. Negotiated Rate	$3,748.67
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	2680340
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	7411704
Hospital Revenue Code	320
Min. Negotiated Rate	$135.76
Max. Negotiated Rate	$1,493.86
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	2680335
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	2680335
Hospital Revenue Code	320
Min. Negotiated Rate	$135.76
Max. Negotiated Rate	$1,493.86
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	7411704
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	7411707
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	7411707
Hospital Revenue Code	320
Min. Negotiated Rate	$214.28
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	2680350
Hospital Revenue Code	320
Min. Negotiated Rate	$214.28
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	2680350
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	2680345
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	7411706
Hospital Revenue Code	320
Min. Negotiated Rate	$197.92
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	7411706
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	2680345
Hospital Revenue Code	320
Min. Negotiated Rate	$197.92
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$757.77
Rate for Payer: Aetna Medicare Advantage	$757.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.10
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	$644.10
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$28,067.97

Service Code	APR-DRG 6944
Min. Negotiated Rate	$23,761.52
Max. Negotiated Rate	$28,067.97
Rate for Payer: Aetna Better Health Medicaid	$27,517.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,067.97
Rate for Payer: Wellpoint Medicaid Managed Care	$23,761.52

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$8,301.30

Service Code	APR-DRG 6941
Min. Negotiated Rate	$6,474.15
Max. Negotiated Rate	$8,301.30
Rate for Payer: Aetna Better Health Medicaid	$8,138.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,301.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6,474.15

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$10,486.49

Service Code	APR-DRG 6942
Min. Negotiated Rate	$7,628.94
Max. Negotiated Rate	$10,486.49
Rate for Payer: Aetna Better Health Medicaid	$10,280.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,486.49
Rate for Payer: Wellpoint Medicaid Managed Care	$7,628.94

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$15,705.16

Service Code	APR-DRG 6943
Min. Negotiated Rate	$12,275.63
Max. Negotiated Rate	$15,705.16
Rate for Payer: Aetna Better Health Medicaid	$15,397.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,705.16
Rate for Payer: Wellpoint Medicaid Managed Care	$12,275.63

LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2101190
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

LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2101190
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

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2250444
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

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2101191
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

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2101191
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

Know your out-of-pocket cost for care.

All Charges