Heights University Hospital

All Charges

Charge

Type

Setting

Price

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
Min. Negotiated Rate	$221.84
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$511.94
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.84
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST BI W/O FOL W/ C

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MR BREAST BI W/O FOL W/ C

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$660.08
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,523.25
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.08
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
Hospital Revenue Code	614
Min. Negotiated Rate	$417.70
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
Min. Negotiated Rate	$221.84
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$511.94
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.84
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$660.08
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,523.25
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.08
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MR BRST WIRE LOC PREOP PLCMT

Facility

$996.25

Hospital Charge Code	2400416
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$498.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MR BRST WIRE LOC PREOP PLCMT

Facility

$996.25

Hospital Charge Code	2400416
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MR CHEST LYMPHADEN H/M W/ C

Facility

$2,210.50

Service Code	HCPCS 71551
Hospital Charge Code	2400110
Hospital Revenue Code	614
Min. Negotiated Rate	$287.37
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$663.15
Rate for Payer: Aetna Medicare Advantage	$663.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.68
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.37
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$331.57
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR CHEST LYMPHADEN H/M W/ C

Facility

$2,210.50

Service Code	HCPCS 71551
Hospital Charge Code	2400110
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MR CHEST LYMPHADEN H/M W/WO C

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	2400111
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR CHEST LYMPHADEN H/M W/WO C

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	2400111
Hospital Revenue Code	614
Min. Negotiated Rate	$830.80
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR DIAG IV INJECT GADOLINIUM

Facility

$261.65

Service Code	HCPCS A9579
Hospital Charge Code	2400398
Hospital Revenue Code	255
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$39.25
Rate for Payer: Qualcare PPO/HMO/WC	$39.25

MR DIAG IV INJECT GADOLINIUM

Facility

$261.65

Service Code	HCPCS A9579
Hospital Charge Code	2400398
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$130.82
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Aetna Medicare Advantage	$78.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.72
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.01
Rate for Payer: Oxford Commercial	$130.82
Rate for Payer: Qualcare PPO/HMO/WC	$39.25
Rate for Payer: UnitedHealthcare Commercial	$130.82

MR GUIDANCE FOR NDL PLACE-GL

Facility

$2,433.20

Service Code	HCPCS 77021
Hospital Charge Code	85000015
Hospital Revenue Code	610
Min. Negotiated Rate	$364.98
Max. Negotiated Rate	$364.98
Rate for Payer: Qualcare PPO/HMO/WC	$364.98

MR GUIDANCE FOR NDL PLACE-GL

Facility

$2,433.20

Service Code	HCPCS 77021
Hospital Charge Code	85000015
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$729.96
Rate for Payer: Aetna Medicare Advantage	$729.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.47
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$316.32
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$364.98
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR GUIDANCE FOR NDL PLACE-PC

Facility

$400.90

Service Code	HCPCS 7702126
Hospital Charge Code	85000025
Hospital Revenue Code	610
Min. Negotiated Rate	$60.13
Max. Negotiated Rate	$60.13
Rate for Payer: Qualcare PPO/HMO/WC	$60.13

MR GUIDANCE FOR NDL PLACE-PC

Facility

$400.90

Service Code	HCPCS 7702126
Hospital Charge Code	85000025
Hospital Revenue Code	610
Min. Negotiated Rate	$52.12
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$120.27
Rate for Payer: Aetna Medicare Advantage	$120.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.23
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.12
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.13
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	7411758
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	2690280
Hospital Revenue Code	610
Min. Negotiated Rate	$121.16
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$279.60
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.66
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.16
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	2690280
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	7411758
Hospital Revenue Code	610
Min. Negotiated Rate	$121.16
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$279.60
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.66
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.16
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

Know your out-of-pocket cost for care.

All Charges