Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERIODIC ACID SCHIFF

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005393
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
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

PERIODIC ACID SCHIFF

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005393
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

PERIODIC ACID SCHIFF PRO K047

Facility

$550.00

Hospital Charge Code	270602670
Hospital Revenue Code	272
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$275.00

PERIODIC ACID SCHIFF PRO K047

Facility

$550.00

Hospital Charge Code	270602670
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PERI OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	74308330
Hospital Revenue Code	514
Min. Negotiated Rate	$73.58
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$169.80
Rate for Payer: Aetna Medicare Advantage	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.33
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.58
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

PERI OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	74308330
Hospital Revenue Code	514
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

PERI OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	74308325
Hospital Revenue Code	761
Min. Negotiated Rate	$58.89
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna Commercial	$135.90
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.89
Rate for Payer: Oxford Commercial	$226.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Commercial	$226.50

PERI OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	74308325
Hospital Revenue Code	761
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

PERI OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	74308270
Hospital Revenue Code	514
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

PERI OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	74308270
Hospital Revenue Code	514
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

PERI OV-NEW-EXTENDED

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	74308285
Hospital Revenue Code	514
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

PERI OV-NEW-EXTENDED

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	74308285
Hospital Revenue Code	514
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

PERI OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	74308280
Hospital Revenue Code	514
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

PERI OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	74308280
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

PERI OXYTOXIN TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	74308040
Hospital Revenue Code	514
Min. Negotiated Rate	$45.64
Max. Negotiated Rate	$481.45
Rate for Payer: Aetna Commercial	$200.70
Rate for Payer: Aetna Medicare Advantage	$200.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.59
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.97
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

PERI OXYTOXIN TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	74308040
Hospital Revenue Code	514
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

PERI PAPP-A

Facility

$110.00

Service Code	HCPCS 84163
Hospital Charge Code	74308205
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PERI PAPP-A

Facility

$110.00

Service Code	HCPCS 84163
Hospital Charge Code	74308205
Hospital Revenue Code	301
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.14
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: Cigna Medicare Advantage	$7.53
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.95
Rate for Payer: Wellcare Medicare Advantage	$15.05

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$8,625.67

Service Code	APR-DRG 1972
Min. Negotiated Rate	$6,513.54
Max. Negotiated Rate	$8,625.67
Rate for Payer: Aetna Better Health Medicaid	$8,456.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,625.67
Rate for Payer: Wellpoint Medicaid Managed Care	$6,513.54

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$21,428.03

Service Code	APR-DRG 1974
Min. Negotiated Rate	$20,892.15
Max. Negotiated Rate	$21,428.03
Rate for Payer: Aetna Better Health Medicaid	$21,007.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,428.03
Rate for Payer: Wellpoint Medicaid Managed Care	$20,892.15

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$12,181.62

Service Code	APR-DRG 1973
Min. Negotiated Rate	$9,673.60
Max. Negotiated Rate	$12,181.62
Rate for Payer: Aetna Better Health Medicaid	$11,942.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,181.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9,673.60

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$6,495.30

Service Code	APR-DRG 1971
Min. Negotiated Rate	$4,878.45
Max. Negotiated Rate	$6,495.30
Rate for Payer: Aetna Better Health Medicaid	$6,367.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,495.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4,878.45

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$9,649.48

Service Code	APR-DRG 0482
Min. Negotiated Rate	$6,618.87
Max. Negotiated Rate	$9,649.48
Rate for Payer: Aetna Better Health Medicaid	$9,460.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,649.48
Rate for Payer: Wellpoint Medicaid Managed Care	$6,618.87

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$8,384.13

Service Code	APR-DRG 0481
Min. Negotiated Rate	$5,895.67
Max. Negotiated Rate	$8,384.13
Rate for Payer: Aetna Better Health Medicaid	$8,219.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,384.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5,895.67

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$13,160.43

Service Code	APR-DRG 0483
Min. Negotiated Rate	$9,233.96
Max. Negotiated Rate	$13,160.43
Rate for Payer: Aetna Better Health Medicaid	$12,902.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,160.43
Rate for Payer: Wellpoint Medicaid Managed Care	$9,233.96

Know your out-of-pocket cost for care.

All Charges