Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERI LOCKING SCREW 3.5.MM X 65

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684879
Hospital Revenue Code	278
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$173.25
Rate for Payer: Aetna Medicare Advantage	$173.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.26
Rate for Payer: Cigna Commercial	$288.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62

PERI LOCKING SCREW 3.5MM X 80M

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684880
Hospital Revenue Code	278
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$139.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62

PERI LOCKING SCREW 3.5MM X 80M

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684880
Hospital Revenue Code	278
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$173.25
Rate for Payer: Aetna Medicare Advantage	$173.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.26
Rate for Payer: Cigna Commercial	$288.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62

PERINEAL PAD SUPINE

Facility

$425.00

Hospital Charge Code	270670483
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

PERINEAL PAD SUPINE

Facility

$425.00

Hospital Charge Code	270670483
Hospital Revenue Code	272
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$212.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$212.50

PERI NON STRESS TEST

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308045
Hospital Revenue Code	920
Min. Negotiated Rate	$246.79
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$569.52
Rate for Payer: Aetna Medicare Advantage	$569.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.09
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.79
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.76
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PERI NON STRESS TEST

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308045
Hospital Revenue Code	920
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.76

PERI OBSERVATION PER HOUR

Facility

$151.00

Service Code	HCPCS 99235
Hospital Charge Code	74308320
Hospital Revenue Code	762
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

PERI OBSERVATION PER HOUR

Facility

$151.00

Service Code	HCPCS 99235
Hospital Charge Code	74308320
Hospital Revenue Code	762
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$45.30
Rate for Payer: Aetna Medicare Advantage	$45.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$621.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.51
Rate for Payer: Cigna Commercial	$154.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.63
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$6,873.00
Rate for Payer: Wellpoint Medicaid Managed Care	$50.00

PERI OB/US<14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76802
Hospital Charge Code	74308100
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 OB/US<14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76802
Hospital Charge Code	74308100
Hospital Revenue Code	402
Min. Negotiated Rate	$67.38
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	$80.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$67.38
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 OB/US>/=14 WKS ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	74308110
Hospital Revenue Code	402
Min. Negotiated Rate	$99.38
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$422.40
Rate for Payer: Aetna Medicare Advantage	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.04
Rate for Payer: Cigna Commercial	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.04
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.20
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI OB/US>/=14 WKS ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	74308110
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

PERI OB/US<14 WKS SINGLE FETUS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	74308095
Hospital Revenue Code	402
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$2,010.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
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: UnitedHealthcare Commercial	$1,981.00

PERI OB/US<14 WKS SINGLE FETUS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	74308095
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 OB/US>/=14 WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	74308105
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 OB/US>/=14 WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	74308105
Hospital Revenue Code	402
Min. Negotiated Rate	$120.80
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$120.80
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PERI OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	74308120
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 OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	74308120
Hospital Revenue Code	402
Min. Negotiated Rate	$219.55
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	$228.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$219.55
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 OB/US DETAILED SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76811
Hospital Charge Code	74308115
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 OB/US DETAILED SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76811
Hospital Charge Code	74308115
Hospital Revenue Code	402
Min. Negotiated Rate	$381.48
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$381.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$568.20
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

PERI OB/US FOLLOW UP PER FETUS

Facility

$6,700.00

Service Code	HCPCS 76816
Hospital Charge Code	74308140
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 OB/US FOLLOW UP PER FETUS

Facility

$6,700.00

Service Code	HCPCS 76816
Hospital Charge Code	74308140
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.68
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	$65.45
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67

PERI OB US-LIMITED

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	74308135
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
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	$65.45
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 OB US-LIMITED

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	74308135
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

Know your out-of-pocket cost for care.

All Charges