Heights University Hospital

All Charges

Charge

Type

Setting

Price

PERI TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
Hospital Revenue Code	402
Min. Negotiated Rate	$151.47
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	$151.47
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 TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
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

PERITRATE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERITRATE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERITRATE SA/TAB

Facility

$3.00

Hospital Charge Code	60634390
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERITRATE SA/TAB

Facility

$3.00

Hospital Charge Code	60634390
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

PERI ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

PERI ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$137.82
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$689.64
Rate for Payer: Aetna Medicare Advantage	$689.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.84
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.82
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

PERI US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
Hospital Revenue Code	402
Min. Negotiated Rate	$38.23
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	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$38.23
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 US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
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 US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
Hospital Revenue Code	402
Min. Negotiated Rate	$124.82
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	$124.82
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

PERI US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
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 US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
Hospital Revenue Code	402
Min. Negotiated Rate	$36.60
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	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$83.49
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 US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
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 UTERINE ART DOPPLER

Facility

$669.00

Service Code	HCPCS 93976
Hospital Charge Code	74308220
Hospital Revenue Code	921
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$5,061.00
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	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.59
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.97
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

PERI UTERINE ART DOPPLER

Facility

$669.00

Service Code	HCPCS 93976
Hospital Charge Code	74308220
Hospital Revenue Code	921
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

PERI VBAC

Facility

$5,539.00

Service Code	HCPCS 59612
Hospital Charge Code	74308075
Hospital Revenue Code	722
Min. Negotiated Rate	$459.91
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	$459.91
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 VBAC

Facility

$5,539.00

Service Code	HCPCS 59612
Hospital Charge Code	74308075
Hospital Revenue Code	722
Min. Negotiated Rate	$830.85
Max. Negotiated Rate	$830.85
Rate for Payer: Qualcare PPO/HMO/WC	$830.85

PERI VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	74308005
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.22
Rate for Payer: Cigna Commercial	$9.34
Rate for Payer: Cigna Medicare Advantage	$4.67
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.90
Rate for Payer: Wellcare Medicare Advantage	$9.34

PERI VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	74308005
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

PERLA 5.5X45MM ROD

Facility

$1,750.00

Hospital Charge Code	270702842
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PERLA 5.5X45MM ROD

Facility

$1,750.00

Hospital Charge Code	270702842
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PERLA CORTICAL 6.5X45MM SCREW

Facility

$3,125.00

Hospital Charge Code	270702838
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

PERLA CORTICAL 6.5X45MM SCREW

Facility

$3,125.00

Hospital Charge Code	270702838
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

PERLA CORTICAL 7.5X40MM SCREW

Facility

$3,125.00

Hospital Charge Code	270702839
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

Know your out-of-pocket cost for care.

All Charges