Heights University Hospital

All Charges

Charge

Type

Setting

Price

OB-US>14 WEEKS, ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	83653045
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$469.14
Rate for Payer: Aetna Medicare Advantage	$469.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.77
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.29
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$335.10
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
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	$284.83
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$335.10
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
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	$284.83
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$99.96
Max. Negotiated Rate	$99.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.96

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$86.63
Max. Negotiated Rate	$205.03
Rate for Payer: Aetna Commercial	$199.93
Rate for Payer: Aetna Medicare Advantage	$199.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.94
Rate for Payer: Cigna Commercial	$205.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.63
Rate for Payer: Qualcare PPO/HMO/WC	$99.96

OBV INP HSP LOW SEVERITY

Facility

$412.93

Service Code	HCPCS 99234
Hospital Charge Code	87502345
Hospital Revenue Code	510
Min. Negotiated Rate	$61.94
Max. Negotiated Rate	$61.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.94

OBV INP HSP LOW SEVERITY

Facility

$412.93

Service Code	HCPCS 99234
Hospital Charge Code	87502345
Hospital Revenue Code	510
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$123.88
Rate for Payer: Aetna Commercial	$123.88
Rate for Payer: Aetna Medicare Advantage	$123.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.30
Rate for Payer: Cigna Commercial	$95.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.68
Rate for Payer: Qualcare PPO/HMO/WC	$61.94

OCA 125

Facility

$143.05

Service Code	HCPCS 86304
Hospital Charge Code	39900468
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

OCA 125

Facility

$143.05

Service Code	HCPCS 86304
Hospital Charge Code	39900468
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$20.81
Rate for Payer: Cigna Medicare Advantage	$10.40
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.06
Rate for Payer: Wellcare Medicare Advantage	$20.81

OCCLUDER DOME HOLE

Facility

$385.00

Hospital Charge Code	270669170
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$115.50
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

OCCLUDER DOME HOLE

Facility

$385.00

Hospital Charge Code	270669170
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

OCCLUSION BALLOON CATHETER

Facility

$681.00

Hospital Charge Code	270331704
Hospital Revenue Code	278
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$164.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

OCCLUSION BALLOON CATHETER

Facility

$774.00

Hospital Charge Code	270332337
Hospital Revenue Code	278
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$232.20
Rate for Payer: Aetna Medicare Advantage	$232.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.37
Rate for Payer: Cigna Commercial	$387.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.10

OCCLUSION BALLOON CATHETER

Facility

$681.00

Hospital Charge Code	270331704
Hospital Revenue Code	278
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna Medicare Advantage	$204.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.66
Rate for Payer: Cigna Commercial	$340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

OCCLUSION BALLOON CATHETER

Facility

$774.00

Hospital Charge Code	270332337
Hospital Revenue Code	278
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$187.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.10

OCCLUSIVE DEVICE IN VEIN ART

Facility

$1,564.00

Service Code	HCPCS G0269
Hospital Charge Code	4110G0269
Hospital Revenue Code	481
Min. Negotiated Rate	$203.32
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$469.20
Rate for Payer: Aetna Medicare Advantage	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.82
Rate for Payer: Cigna Commercial	$782.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.32
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.60
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

OCCLUSIVE DEVICE IN VEIN ART

Facility

$1,564.00

Service Code	HCPCS G0269
Hospital Charge Code	4110G0269
Hospital Revenue Code	481
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$234.60
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

OCCULAR OCCLUDERS

Facility

$44.00

Hospital Charge Code	270335277
Hospital Revenue Code	272
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$22.00

OCCULAR OCCLUDERS

Facility

$44.00

Hospital Charge Code	270335277
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

OCCULT BLOOD

Facility

$121.00

Service Code	HCPCS 82270
Hospital Charge Code	38475023
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

OCCULT BLOOD

Facility

$121.00

Service Code	HCPCS 82270
Hospital Charge Code	38475023
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$4.38
Rate for Payer: Cigna Medicare Advantage	$2.19
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.64
Rate for Payer: Wellcare Medicare Advantage	$4.38

Know your out-of-pocket cost for care.

All Charges