Heights University Hospital

All Charges

Charge

Type

Setting

Price

OVA AND PARISITE IDENTIFICATIO

Facility

$122.60

Service Code	HCPCS 87209
Hospital Charge Code	3990161B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.39
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

OVAL BURR

Facility

$119.00

Hospital Charge Code	270332555
Hospital Revenue Code	272
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$59.50
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare Advantage	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.34
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.47
Rate for Payer: Oxford Commercial	$59.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$59.50

OVAL BURR

Facility

$119.00

Hospital Charge Code	270332555
Hospital Revenue Code	272
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

Ova + Parasite Exam

Facility

$526.67

Service Code	HCPCS 87177
Hospital Charge Code	39880003A
Hospital Revenue Code	309
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.00

Ova + Parasite Exam

Facility

$667.59

Service Code	HCPCS 87209
Hospital Charge Code	39880003B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

Ova + Parasite Exam

Facility

$526.67

Service Code	HCPCS 87177
Hospital Charge Code	39880003A
Hospital Revenue Code	309
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.84
Rate for Payer: Aetna Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: Cigna Medicare Advantage	$4.45
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.43
Rate for Payer: Wellcare Medicare Advantage	$8.90

Ova + Parasite Exam

Facility

$667.59

Service Code	HCPCS 87209
Hospital Charge Code	39880003B
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

OVA & PARASITES

Facility

$391.00

Service Code	HCPCS 87177
Hospital Charge Code	38475005
Hospital Revenue Code	309
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.84
Rate for Payer: Aetna Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: Cigna Medicare Advantage	$4.45
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.43
Rate for Payer: Wellcare Medicare Advantage	$8.90

OVA & PARASITES

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3002011
Hospital Revenue Code	309
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.84
Rate for Payer: Aetna Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: Cigna Medicare Advantage	$4.45
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.43
Rate for Payer: Wellcare Medicare Advantage	$8.90

OVA & PARASITES

Facility

$391.00

Service Code	HCPCS 87177
Hospital Charge Code	38475005
Hospital Revenue Code	309
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

OVA & PARASITES

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3002011
Hospital Revenue Code	309
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

OVA & PARASITES***

Facility

$32.00

Hospital Charge Code	3012010
Hospital Revenue Code	309
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

OVA & PARASITES***

Facility

$32.00

Hospital Charge Code	3012010
Hospital Revenue Code	309
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

OVARIAN AB SCREEN

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	38479451A
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
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
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

OVARIAN AB SCREEN

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	38479451A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OVARIAN MALIGNANCY RISK-ROMA

Facility

$540.59

Service Code	HCPCS 86849
Hospital Charge Code	3038139
Hospital Revenue Code	302
Min. Negotiated Rate	$70.28
Max. Negotiated Rate	$270.30
Rate for Payer: Aetna Commercial	$162.18
Rate for Payer: Aetna Medicare Advantage	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.85
Rate for Payer: Cigna Commercial	$270.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.09
Rate for Payer: UnitedHealthcare Commercial	$114.00

OVARIAN MALIGNANCY RISK-ROMA

Facility

$540.59

Service Code	HCPCS 86849
Hospital Charge Code	3038139
Hospital Revenue Code	302
Min. Negotiated Rate	$81.09
Max. Negotiated Rate	$81.09
Rate for Payer: Qualcare PPO/HMO/WC	$81.09

OVERDRILL 2.7MM AO CONNECTION

Facility

$1,205.00

Hospital Charge Code	270672587
Hospital Revenue Code	272
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$180.75
Rate for Payer: Qualcare PPO/HMO/WC	$180.75

OVERDRILL 2.7MM AO CONNECTION

Facility

$1,205.00

Hospital Charge Code	270672587
Hospital Revenue Code	272
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$602.50
Rate for Payer: Aetna Commercial	$361.50
Rate for Payer: Aetna Medicare Advantage	$361.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.27
Rate for Payer: Cigna Commercial	$602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.65
Rate for Payer: Oxford Commercial	$602.50
Rate for Payer: Qualcare PPO/HMO/WC	$180.75
Rate for Payer: UnitedHealthcare Commercial	$602.50

OVERDRILL 3.5

Facility

$1,370.00

Hospital Charge Code	270664509
Hospital Revenue Code	270
Min. Negotiated Rate	$205.50
Max. Negotiated Rate	$205.50
Rate for Payer: Qualcare PPO/HMO/WC	$205.50

OVERDRILL 3.5

Facility

$1,370.00

Hospital Charge Code	270664509
Hospital Revenue Code	270
Min. Negotiated Rate	$178.10
Max. Negotiated Rate	$685.00
Rate for Payer: Aetna Commercial	$411.00
Rate for Payer: Aetna Medicare Advantage	$411.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.35
Rate for Payer: Cigna Commercial	$685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.10
Rate for Payer: Oxford Commercial	$685.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.50
Rate for Payer: UnitedHealthcare Commercial	$685.00

OVERDRILL AO DIA 3.5X122MM

Facility

$1,160.70

Hospital Charge Code	270692182
Hospital Revenue Code	272
Min. Negotiated Rate	$174.10
Max. Negotiated Rate	$174.10
Rate for Payer: Qualcare PPO/HMO/WC	$174.10

OVERDRILL AO DIA 3.5X122MM

Facility

$1,160.70

Hospital Charge Code	270692182
Hospital Revenue Code	272
Min. Negotiated Rate	$150.89
Max. Negotiated Rate	$580.35
Rate for Payer: Aetna Commercial	$348.21
Rate for Payer: Aetna Medicare Advantage	$348.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.98
Rate for Payer: Cigna Commercial	$580.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.89
Rate for Payer: Oxford Commercial	$580.35
Rate for Payer: Qualcare PPO/HMO/WC	$174.10
Rate for Payer: UnitedHealthcare Commercial	$580.35

OVERDRILL AO SHAFT END 2.3mm

Facility

$860.00

Hospital Charge Code	270669953
Hospital Revenue Code	272
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$258.00
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.80
Rate for Payer: Oxford Commercial	$430.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Commercial	$430.00

OVERDRILL AO SHAFT END 2.3mm

Facility

$860.00

Hospital Charge Code	270669953
Hospital Revenue Code	272
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

Know your out-of-pocket cost for care.

All Charges