Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW CRYO PREML LESION,1ST

Facility

$372.00

Service Code	HCPCS 17000
Hospital Charge Code	87502075
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW DEBRID SKIN & SUBC TISSUE

Facility

$499.00

Service Code	HCPCS 11042
Hospital Charge Code	84206020
Hospital Revenue Code	761
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$149.70
Rate for Payer: Aetna Medicare Advantage	$149.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.25
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.87
Rate for Payer: Oxford Commercial	$249.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.85
Rate for Payer: UnitedHealthcare Commercial	$249.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

RW DEBRID SKIN & SUBC TISSUE

Facility

$499.00

Service Code	HCPCS 11042
Hospital Charge Code	84206020
Hospital Revenue Code	761
Min. Negotiated Rate	$74.85
Max. Negotiated Rate	$74.85
Rate for Payer: Qualcare PPO/HMO/WC	$74.85

RW DEBRID SKIN & SUB TIS

Facility

$499.00

Service Code	HCPCS 11042
Hospital Charge Code	87502085
Hospital Revenue Code	761
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$1,058.74
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Aetna Better Health Medicaid	$1,037.98
Rate for Payer: Aetna Commercial	$149.70
Rate for Payer: Aetna Medicare Advantage	$149.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.87
Rate for Payer: Oxford Commercial	$249.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.85
Rate for Payer: UnitedHealthcare Commercial	$249.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74

RW DEBRID SKIN & SUB TIS

Facility

$499.00

Service Code	HCPCS 11042
Hospital Charge Code	87502085
Hospital Revenue Code	761
Min. Negotiated Rate	$74.85
Max. Negotiated Rate	$74.85
Rate for Payer: Qualcare PPO/HMO/WC	$74.85

RW DTAP-HIB-IPV INTRAMUSCULAR

Facility

$140.00

Service Code	HCPCS 90698
Hospital Charge Code	84206395
Hospital Revenue Code	636
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

RW DTAP-HIB-IPV INTRAMUSCULAR

Facility

$140.00

Service Code	HCPCS 90698
Hospital Charge Code	84206395
Hospital Revenue Code	636
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

RW EKG 12 LEADS

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84206285
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$603.00
Rate for Payer: Aetna Commercial	$197.40
Rate for Payer: Aetna Medicare Advantage	$197.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.79
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.54
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$603.00

RW EKG 12 LEADS

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84206285
Hospital Revenue Code	730
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

RW EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	87502195
Hospital Revenue Code	730
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

RW EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	87502195
Hospital Revenue Code	730
Min. Negotiated Rate	$70.15
Max. Negotiated Rate	$615.00
Rate for Payer: Aetna Commercial	$615.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.50
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$603.00

RW ENDOMETRIAL BIOPSY

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	87502190
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

RW ENDOMETRIAL BIOPSY

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	84206115
Hospital Revenue Code	361
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$1,864.00
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	$1,864.00
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: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

RW ENDOMETRIAL BIOPSY

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	87502190
Hospital Revenue Code	361
Min. Negotiated Rate	$86.97
Max. Negotiated Rate	$1,864.00
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	$1,864.00
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: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

RW ENDOMETRIAL BIOPSY

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	84206115
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

RW ENGERIX 20 MCG/1ML HEP B AD

Facility

$114.00

Service Code	HCPCS 90746
Hospital Charge Code	84206220
Hospital Revenue Code	636
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$75.15
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$75.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

RW ENGERIX 20 MCG/1ML HEP B AD

Facility

$114.00

Service Code	HCPCS 90746
Hospital Charge Code	84206220
Hospital Revenue Code	636
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$27.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

RW EST. PT - VISIT - COMPREHEN

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84206355
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

RW EST. PT - VISIT - COMPREHEN

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84206355
Hospital Revenue Code	510
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$364.14
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

RW EST. PT - VISIT - DETAILED

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	84206405
Hospital Revenue Code	510
Min. Negotiated Rate	$36.76
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$84.84
Rate for Payer: Aetna Medicare Advantage	$84.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.11
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.76
Rate for Payer: Qualcare PPO/HMO/WC	$42.42

RW EST. PT - VISIT - DETAILED

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	84206405
Hospital Revenue Code	510
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$42.42
Rate for Payer: Qualcare PPO/HMO/WC	$42.42

RW EST.PT-VISIT-DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84206350
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW EST.PT-VISIT-DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84206350
Hospital Revenue Code	510
Min. Negotiated Rate	$91.37
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	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW EST. PT - VISIT - EXPANDED

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84206345
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

RW EST. PT - VISIT - EXPANDED

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84206345
Hospital Revenue Code	510
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$196.56
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

Know your out-of-pocket cost for care.

All Charges