Heights University Hospital

All Charges

Charge

Type

Setting

Price

MAMMO ONE BRST-TC

Facility

$316.65

Service Code	HCPCS 77055TC
Hospital Charge Code	85000130
Hospital Revenue Code	401
Min. Negotiated Rate	$41.16
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.75
Rate for Payer: Cigna Commercial	$158.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.16
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.50
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

MAMMOPLASTY,REDUCTION

Facility

$42,601.70

Service Code	HCPCS 19318
Hospital Charge Code	16000335
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$15,812.86
Rate for Payer: Aetna Commercial	$12,780.51
Rate for Payer: Aetna Medicare Advantage	$12,780.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,863.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,863.43
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	$10,863.43
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,538.22
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

MAMMOPLASTY,REDUCTION

Facility

$42,601.70

Service Code	HCPCS 19318
Hospital Charge Code	16000335
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

MAMMO SCREENING-BILAT

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	94061189
Hospital Revenue Code	403
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$91.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.14

MAMMO SCREENING-BILAT

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	94061189
Hospital Revenue Code	403
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$182.28
Rate for Payer: Aetna Medicare Advantage	$182.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.94
Rate for Payer: Cigna Commercial	$303.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.99
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.14
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

MAMMO SCREENING-GL

Facility

$464.30

Service Code	HCPCS 77057
Hospital Charge Code	85000155
Hospital Revenue Code	403
Min. Negotiated Rate	$60.36
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$139.29
Rate for Payer: Aetna Medicare Advantage	$139.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.40
Rate for Payer: Cigna Commercial	$232.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.36
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.64
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

MAMMO SCREENING-GL

Facility

$464.30

Service Code	HCPCS 77057
Hospital Charge Code	85000155
Hospital Revenue Code	403
Min. Negotiated Rate	$69.64
Max. Negotiated Rate	$69.64
Rate for Payer: Qualcare PPO/HMO/WC	$69.64

MAMMO SCREENING-PC

Facility

$186.00

Service Code	HCPCS 7705726
Hospital Charge Code	85000165
Hospital Revenue Code	403
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

MAMMO SCREENING-PC

Facility

$186.00

Service Code	HCPCS 7705726
Hospital Charge Code	85000165
Hospital Revenue Code	403
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.18
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

MAMMO SCREENING-TC

Facility

$278.30

Service Code	HCPCS 77057TC
Hospital Charge Code	85000160
Hospital Revenue Code	403
Min. Negotiated Rate	$41.74
Max. Negotiated Rate	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$41.74

MAMMO SCREENING-TC

Facility

$278.30

Service Code	HCPCS 77057TC
Hospital Charge Code	85000160
Hospital Revenue Code	403
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$83.49
Rate for Payer: Aetna Medicare Advantage	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.97
Rate for Payer: Cigna Commercial	$139.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.18
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.74
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

MAMMOTOME BIOPSY SITE IDENTIFI

Facility

$492.00

Hospital Charge Code	26702050
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

MAMMOTOME BIOPSY SITE IDENTIFI

Facility

$492.00

Hospital Charge Code	26702050
Hospital Revenue Code	272
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$147.60
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.96
Rate for Payer: Oxford Commercial	$246.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$246.00

MAMMOTOME PROBE

Facility

$1,475.00

Hospital Charge Code	26702052
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

MAMMOTOME PROBE

Facility

$1,475.00

Hospital Charge Code	26702052
Hospital Revenue Code	272
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

MAMMOTOME STANDARD BREAST MARK

Facility

$1,968.00

Hospital Charge Code	270663458
Hospital Revenue Code	272
Min. Negotiated Rate	$295.20
Max. Negotiated Rate	$295.20
Rate for Payer: Qualcare PPO/HMO/WC	$295.20

MAMMOTOME STANDARD BREAST MARK

Facility

$1,968.00

Hospital Charge Code	270663458
Hospital Revenue Code	272
Min. Negotiated Rate	$255.84
Max. Negotiated Rate	$984.00
Rate for Payer: Aetna Commercial	$590.40
Rate for Payer: Aetna Medicare Advantage	$590.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.84
Rate for Payer: Cigna Commercial	$984.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.84
Rate for Payer: Oxford Commercial	$984.00
Rate for Payer: Qualcare PPO/HMO/WC	$295.20
Rate for Payer: UnitedHealthcare Commercial	$984.00

MAMMOTOME STAR MARKER

Facility

$492.00

Hospital Charge Code	26702048
Hospital Revenue Code	272
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$147.60
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.96
Rate for Payer: Oxford Commercial	$246.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$246.00

MAMMOTOME STAR MARKER

Facility

$492.00

Hospital Charge Code	26702048
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

MANDELAMINE/1GM/TAB

Facility

$3.00

Hospital Charge Code	60633352
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MANDELAMINE/1GM/TAB

Facility

$3.00

Hospital Charge Code	60633352
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

MANDIBLE COMP 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70110
Hospital Charge Code	94061001
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

MANDIBLE COMP 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70110
Hospital Charge Code	94061001
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,627.00
Rate for Payer: Aetna Better Health Medicaid	$1,595.10
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00

MANGANESE

Facility

$174.15

Service Code	HCPCS 83785
Hospital Charge Code	38477175
Hospital Revenue Code	301
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.35
Rate for Payer: Aetna Medicare Advantage	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.65
Rate for Payer: Cigna Commercial	$26.65
Rate for Payer: Cigna Medicare Advantage	$13.32
Rate for Payer: Clover Medicare Advantage	$25.32
Rate for Payer: EmblemHealth Commercial	$79.95
Rate for Payer: Humana Medicare Advantage	$27.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.12
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.65
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.25
Rate for Payer: Wellcare Medicare Advantage	$26.65

MANGANESE

Facility

$174.15

Service Code	HCPCS 83785
Hospital Charge Code	38477175
Hospital Revenue Code	301
Min. Negotiated Rate	$26.12
Max. Negotiated Rate	$26.12
Rate for Payer: Qualcare PPO/HMO/WC	$26.12

Know your out-of-pocket cost for care.

All Charges