Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERI COLOR FLOW MAPPING

Facility

$800.00

Service Code	HCPCS 93325
Hospital Charge Code	74308215
Hospital Revenue Code	483
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

PERI D&C

Facility

$5,166.00

Service Code	HCPCS 59160
Hospital Charge Code	74308050
Hospital Revenue Code	514
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$1,549.80
Rate for Payer: Aetna Medicare Advantage	$1,549.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.33
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.58
Rate for Payer: Qualcare PPO/HMO/WC	$774.90

PERI D&C

Facility

$5,166.00

Service Code	HCPCS 59160
Hospital Charge Code	74308050
Hospital Revenue Code	514
Min. Negotiated Rate	$774.90
Max. Negotiated Rate	$774.90
Rate for Payer: Qualcare PPO/HMO/WC	$774.90

PERI DELIVER PLACENTA

Facility

$5,539.00

Service Code	HCPCS 59414
Hospital Charge Code	74308070
Hospital Revenue Code	720
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$1,661.70
Rate for Payer: Aetna Medicare Advantage	$1,661.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,412.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,412.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,412.44
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.07
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$830.85
Rate for Payer: UnitedHealthcare Commercial	$2,979.00

PERI DELIVER PLACENTA

Facility

$5,539.00

Service Code	HCPCS 59414
Hospital Charge Code	74308070
Hospital Revenue Code	720
Min. Negotiated Rate	$830.85
Max. Negotiated Rate	$830.85
Rate for Payer: Qualcare PPO/HMO/WC	$830.85

PERIDEX 0.12%/480ML

Facility

$53.00

Hospital Charge Code	60633633
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

PERIDEX 0.12%/480ML

Facility

$53.00

Hospital Charge Code	60633633
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$26.50
Rate for Payer: Aetna Commercial	$15.90
Rate for Payer: Aetna Medicare Advantage	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.52
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.89
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$26.50

PERI DOPPLER MCA

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	74308165
Hospital Revenue Code	402
Min. Negotiated Rate	$93.73
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$216.30
Rate for Payer: Aetna Medicare Advantage	$216.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.85
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.73
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI DOPPLER MCA

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	74308165
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

PERI ECHO EXAM OF FETAL HEART

Facility

$1,139.00

Service Code	HCPCS 76827
Hospital Charge Code	74308180
Hospital Revenue Code	402
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$341.70
Rate for Payer: Aetna Medicare Advantage	$341.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.44
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.07
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$170.85
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI ECHO EXAM OF FETAL HEART

Facility

$1,139.00

Service Code	HCPCS 76827
Hospital Charge Code	74308180
Hospital Revenue Code	402
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$170.85
Rate for Payer: Qualcare PPO/HMO/WC	$170.85

PERI EPIS OR VAGINAL REPAIR

Facility

$9,489.90

Service Code	HCPCS 59300
Hospital Charge Code	74308055
Hospital Revenue Code	514
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

PERI EPIS OR VAGINAL REPAIR

Facility

$9,489.90

Service Code	HCPCS 59300
Hospital Charge Code	74308055
Hospital Revenue Code	514
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$2,846.97
Rate for Payer: Aetna Medicare Advantage	$2,846.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,419.92
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,233.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

PERI EVACUATION OF HEMATOMA

Facility

$1,671.00

Service Code	HCPCS 10160
Hospital Charge Code	74308001
Hospital Revenue Code	361
Min. Negotiated Rate	$217.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$501.30
Rate for Payer: Aetna Medicare Advantage	$501.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.11
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	$426.11
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.23
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

PERI EVACUATION OF HEMATOMA

Facility

$1,671.00

Service Code	HCPCS 10160
Hospital Charge Code	74308001
Hospital Revenue Code	361
Min. Negotiated Rate	$250.65
Max. Negotiated Rate	$250.65
Rate for Payer: Qualcare PPO/HMO/WC	$250.65

PERI EXAM UNDER ANESTHESIA

Facility

$5,905.00

Service Code	HCPCS 57410
Hospital Charge Code	74308020
Hospital Revenue Code	514
Min. Negotiated Rate	$885.75
Max. Negotiated Rate	$885.75
Rate for Payer: Qualcare PPO/HMO/WC	$885.75

PERI EXAM UNDER ANESTHESIA

Facility

$5,905.00

Service Code	HCPCS 57410
Hospital Charge Code	74308020
Hospital Revenue Code	514
Min. Negotiated Rate	$44.27
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$1,771.50
Rate for Payer: Aetna Medicare Advantage	$1,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,505.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,505.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,505.78
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.65
Rate for Payer: Qualcare PPO/HMO/WC	$885.75

PERI EXTERNAL VERSION

Facility

$5,345.00

Service Code	HCPCS 59412
Hospital Charge Code	74308065
Hospital Revenue Code	720
Min. Negotiated Rate	$801.75
Max. Negotiated Rate	$801.75
Rate for Payer: Qualcare PPO/HMO/WC	$801.75

PERI EXTERNAL VERSION

Facility

$5,345.00

Service Code	HCPCS 59412
Hospital Charge Code	74308065
Hospital Revenue Code	720
Min. Negotiated Rate	$54.61
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$1,603.50
Rate for Payer: Aetna Medicare Advantage	$1,603.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,362.97
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$694.85
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$801.75
Rate for Payer: UnitedHealthcare Commercial	$2,979.00

PERI FETAL BIOPHY PFILE WO/NST

Facility

$6,700.00

Service Code	HCPCS 76819
Hospital Charge Code	74308155
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI FETAL BIOPHY PFILE WO/NST

Facility

$6,700.00

Service Code	HCPCS 76819
Hospital Charge Code	74308155
Hospital Revenue Code	402
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
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	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI FETAL BIOPHY PRFILE W/NST

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	74308150
Hospital Revenue Code	402
Min. Negotiated Rate	$113.14
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI FETAL BIOPHY PRFILE W/NST

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	74308150
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI FETAL DOPPLER REPEAT

Facility

$6,700.00

Service Code	HCPCS 76828
Hospital Charge Code	74308185
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI FETAL DOPPLER REPEAT

Facility

$6,700.00

Service Code	HCPCS 76828
Hospital Charge Code	74308185
Hospital Revenue Code	402
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

Know your out-of-pocket cost for care.

All Charges