Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW SKIN TAG REM @ ADDTL 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	87502265
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	84206045
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	87502155
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	87502155
Hospital Revenue Code	761
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

RW SKIN TAG REMOVAL UP TO 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	84206045
Hospital Revenue Code	761
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

RW SKIN TAG REMVL @ ADD'L 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	84206050
Hospital Revenue Code	510
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW SKIN TAG REMVL @ ADD'L 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	84206050
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

RW STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	84206155
Hospital Revenue Code	302
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.39
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$11.54
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.23
Rate for Payer: Wellcare Medicare Advantage	$11.54

RW STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	84206155
Hospital Revenue Code	302
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

RW TDAP > 7 YRS

Facility

$181.15

Service Code	HCPCS 90715
Hospital Charge Code	87502860
Hospital Revenue Code	636
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$43.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

RW TDAP > 7 YRS

Facility

$181.15

Service Code	HCPCS 90715
Hospital Charge Code	87502860
Hospital Revenue Code	636
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$54.34
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$39.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	84206280
Hospital Revenue Code	471
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	87502270
Hospital Revenue Code	471
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	84206280
Hospital Revenue Code	471
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$1,180.00
Rate for Payer: Aetna Commercial	$58.20
Rate for Payer: Aetna Medicare Advantage	$58.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.47
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	$49.47
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

RW TYMPANOMETRY IMPEND TESTING

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	87502270
Hospital Revenue Code	471
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$1,180.00
Rate for Payer: Aetna Commercial	$58.20
Rate for Payer: Aetna Medicare Advantage	$58.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.47
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	$49.47
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

RW URINALYSIS ,DIP STICK TAB

Facility

$40.00

Service Code	HCPCS 81002
Hospital Charge Code	84206135
Hospital Revenue Code	307
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

RW URINALYSIS ,DIP STICK TAB

Facility

$40.00

Service Code	HCPCS 81002
Hospital Charge Code	84206135
Hospital Revenue Code	307
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: Cigna Medicare Advantage	$1.74
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.69
Rate for Payer: Wellcare Medicare Advantage	$3.48

RW URINALYSIS, DIP STICK TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502320
Hospital Revenue Code	307
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: Cigna Medicare Advantage	$1.74
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.69
Rate for Payer: Wellcare Medicare Advantage	$3.48

RW URINALYSIS, DIP STICK TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502320
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	87502325
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	84206140
Hospital Revenue Code	307
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.90
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: Cigna Medicare Advantage	$4.30
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.13
Rate for Payer: Wellcare Medicare Advantage	$8.61

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	84206140
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

RW URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	87502325
Hospital Revenue Code	307
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$27.90
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: Cigna Medicare Advantage	$4.30
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.13
Rate for Payer: Wellcare Medicare Advantage	$8.61

RW VARICELLA

Facility

$504.00

Service Code	HCPCS 90716
Hospital Charge Code	87502856
Hospital Revenue Code	636
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna Commercial	$151.20
Rate for Payer: Aetna Medicare Advantage	$151.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.52
Rate for Payer: Cigna Commercial	$252.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.97
Rate for Payer: Qualcare PPO/HMO/WC	$75.60

RW VARICELLA

Facility

$504.00

Service Code	HCPCS 90716
Hospital Charge Code	87502856
Hospital Revenue Code	636
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$121.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.97
Rate for Payer: Qualcare PPO/HMO/WC	$75.60

Know your out-of-pocket cost for care.

All Charges