Heights University Hospital

All Charges

Charge

Type

Setting

Price

PAP IG, CT-NG, HPV-HR IV

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038521D
Hospital Revenue Code	310
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

PAP IG, CT-NT, RFX HPV ASCU

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038522C
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PAP IG, CT-NT, RFX HPV ASCU

Facility

$210.00

Service Code	HCPCS 87591
Hospital Charge Code	3038522B
Hospital Revenue Code	300
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

PAP IG, CT-NT, RFX HPV ASCU

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038522C
Hospital Revenue Code	310
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

PAP IG, CT-NT, RFX HPV ASCU

Facility

$223.00

Service Code	HCPCS 87491
Hospital Charge Code	3038522A
Hospital Revenue Code	300
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$33.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

PAP IG, CT-NT, RFX HPV ASCU

Facility

$223.00

Service Code	HCPCS 87491
Hospital Charge Code	3038522A
Hospital Revenue Code	300
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

PAP IG, CT-NT, RFX HPV ASCU

Facility

$210.00

Service Code	HCPCS 87591
Hospital Charge Code	3038522B
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

PAPILLOMAVIRUS,DNA PROBE TISSU

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009110
Hospital Revenue Code	312
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$96.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

PAPILLOMAVIRUS,DNA PROBE TISSU

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009110
Hospital Revenue Code	312
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOMAVIRUS, HUMAN #1

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009115A
Hospital Revenue Code	310
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$96.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

PAPILLOMAVIRUS, HUMAN #1

Facility

$350.00

Service Code	HCPCS 88365
Hospital Charge Code	3009115A
Hospital Revenue Code	310
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOMAVIRUS, HUMAN #2

Facility

$350.00

Service Code	HCPCS 8836591
Hospital Charge Code	3009115B
Hospital Revenue Code	310
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

PAPILLOMAVIRUS, HUMAN #2

Facility

$350.00

Service Code	HCPCS 8836591
Hospital Charge Code	3009115B
Hospital Revenue Code	310
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

PAPILLOTOME FRIMBERGER PT30FK

Facility

$652.00

Hospital Charge Code	270606338
Hospital Revenue Code	270
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$326.00
Rate for Payer: Aetna Commercial	$195.60
Rate for Payer: Aetna Medicare Advantage	$195.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.26
Rate for Payer: Cigna Commercial	$326.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.76
Rate for Payer: Oxford Commercial	$326.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.80
Rate for Payer: UnitedHealthcare Commercial	$326.00

PAPILLOTOME FRIMBERGER PT30FK

Facility

$652.00

Hospital Charge Code	270606338
Hospital Revenue Code	270
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$97.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.80

PAPILLOTOME SOEHEN PT5.5BII

Facility

$1,073.65

Hospital Charge Code	270600986
Hospital Revenue Code	270
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$161.05
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

PAPILLOTOME SOEHEN PT5.5BII

Facility

$1,073.65

Hospital Charge Code	270600986
Hospital Revenue Code	270
Min. Negotiated Rate	$139.57
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$322.10
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.57
Rate for Payer: Oxford Commercial	$536.83
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Commercial	$536.83

PAPILLOTOME TAPERTOME 3.5 3282

Facility

$1,226.45

Hospital Charge Code	270608081
Hospital Revenue Code	272
Min. Negotiated Rate	$183.97
Max. Negotiated Rate	$183.97
Rate for Payer: Qualcare PPO/HMO/WC	$183.97

PAPILLOTOME TAPERTOME 3.5 3282

Facility

$1,226.45

Hospital Charge Code	270608081
Hospital Revenue Code	272
Min. Negotiated Rate	$159.44
Max. Negotiated Rate	$613.23
Rate for Payer: Aetna Commercial	$367.94
Rate for Payer: Aetna Medicare Advantage	$367.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.74
Rate for Payer: Cigna Commercial	$613.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.44
Rate for Payer: Oxford Commercial	$613.23
Rate for Payer: Qualcare PPO/HMO/WC	$183.97
Rate for Payer: UnitedHealthcare Commercial	$613.23

PAPILLOTOME WC ZIM 5F PTHPC-1

Facility

$652.00

Hospital Charge Code	270609427
Hospital Revenue Code	272
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$326.00
Rate for Payer: Aetna Commercial	$195.60
Rate for Payer: Aetna Medicare Advantage	$195.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.26
Rate for Payer: Cigna Commercial	$326.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.76
Rate for Payer: Oxford Commercial	$326.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.80
Rate for Payer: UnitedHealthcare Commercial	$326.00

PAPILLOTOME WC ZIM 5F PTHPC-1

Facility

$652.00

Hospital Charge Code	270609427
Hospital Revenue Code	272
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$97.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.80

PAPILLOTOME ZIMMON 5F PTH-30

Facility

$652.00

Hospital Charge Code	270600981
Hospital Revenue Code	270
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$326.00
Rate for Payer: Aetna Commercial	$195.60
Rate for Payer: Aetna Medicare Advantage	$195.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.26
Rate for Payer: Cigna Commercial	$326.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.76
Rate for Payer: Oxford Commercial	$326.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.80
Rate for Payer: UnitedHealthcare Commercial	$326.00

PAPILLOTOME ZIMMON 5F PTH-30

Facility

$652.00

Hospital Charge Code	270600981
Hospital Revenue Code	270
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$97.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.80

PAP IMAGE GUIDED, HPV HIGH RIS

Facility

$249.00

Service Code	HCPCS 87624
Hospital Charge Code	3038081A
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

PAP IMAGE GUIDED, HPV HIGH RIS

Facility

$672.00

Service Code	HCPCS 88175
Hospital Charge Code	3038081B
Hospital Revenue Code	311
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.22
Rate for Payer: Aetna Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.50
Rate for Payer: Cigna Commercial	$26.61
Rate for Payer: Cigna Medicare Advantage	$13.30
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28.21
Rate for Payer: Wellcare Medicare Advantage	$26.61

Know your out-of-pocket cost for care.

All Charges