Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	2709037
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$143.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$143.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$143.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$121.50
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.65
Rate for Payer: Oxford Commercial	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$202.50

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$182.28
Rate for Payer: Aetna Medicare Advantage	$182.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.94
Rate for Payer: Cigna Commercial	$303.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.99
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.14
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$91.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.14

SCREEN SYN TT MESH 1 100/100**

Facility

$1,638.00

Hospital Charge Code	270607186
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$396.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.40
Rate for Payer: Qualcare PPO/HMO/WC	$245.70

SCREEN SYN TT MESH 1 100/100**

Facility

$1,638.00

Hospital Charge Code	270607186
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$819.00
Rate for Payer: Aetna Commercial	$491.40
Rate for Payer: Aetna Medicare Advantage	$491.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.69
Rate for Payer: Cigna Commercial	$819.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.40
Rate for Payer: Qualcare PPO/HMO/WC	$245.70

SCREW

Facility

$117.80

Hospital Charge Code	270657083
Hospital Revenue Code	278
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.51
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

SCREW

Facility

$7,678.35

Service Code	HCPCS C1713
Hospital Charge Code	270685047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.75
Max. Negotiated Rate	$3,839.18
Rate for Payer: Aetna Commercial	$2,303.51
Rate for Payer: Aetna Medicare Advantage	$2,303.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.98
Rate for Payer: Cigna Commercial	$3,839.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.75

SCREW

Facility

$450.00

Hospital Charge Code	270703022
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

SCREW

Facility

$7,678.35

Service Code	HCPCS C1713
Hospital Charge Code	270685047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.75
Max. Negotiated Rate	$1,858.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.75

SCREW

Facility

$515.00

Service Code	HCPCS C1713
Hospital Charge Code	270660699
Hospital Revenue Code	278
Min. Negotiated Rate	$77.25
Max. Negotiated Rate	$124.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.63
Rate for Payer: Qualcare PPO/HMO/WC	$77.25

SCREW

Facility

$515.00

Service Code	HCPCS C1713
Hospital Charge Code	270660699
Hospital Revenue Code	278
Min. Negotiated Rate	$77.25
Max. Negotiated Rate	$257.50
Rate for Payer: Aetna Commercial	$154.50
Rate for Payer: Aetna Medicare Advantage	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.32
Rate for Payer: Cigna Commercial	$257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.63
Rate for Payer: Qualcare PPO/HMO/WC	$77.25

SCREW

Facility

$515.00

Hospital Charge Code	270660700
Hospital Revenue Code	278
Min. Negotiated Rate	$77.25
Max. Negotiated Rate	$257.50
Rate for Payer: Qualcare PPO/HMO/WC	$77.25
Rate for Payer: Aetna Commercial	$154.50
Rate for Payer: Aetna Medicare Advantage	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.32
Rate for Payer: Cigna Commercial	$257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.63

SCREW

Facility

$655.20

Hospital Charge Code	270339473
Hospital Revenue Code	278
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$158.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

SCREW

Facility

$117.80

Hospital Charge Code	270657080
Hospital Revenue Code	278
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$28.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.51
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

SCREW

Facility

$117.80

Hospital Charge Code	270657081
Hospital Revenue Code	278
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$58.90
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna Medicare Advantage	$35.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.04
Rate for Payer: Cigna Commercial	$58.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.51
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

Know your out-of-pocket cost for care.

All Charges