Heights University Hospital

All Charges

Charge

Type

Setting

Price

SP SPEECH EVALUATION

Facility

$2,400.00

Service Code	HCPCS 92523GN
Hospital Charge Code	9000308
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SP SPEECH TX INDIVIDUAL

Facility

$167.25

Service Code	HCPCS 92507GN
Hospital Charge Code	9000316
Hospital Revenue Code	440
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

SP SPEECH TX INDIVIDUAL

Facility

$167.25

Service Code	HCPCS 92507GN
Hospital Charge Code	9000316
Hospital Revenue Code	440
Min. Negotiated Rate	$21.74
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.74
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$686.00

SP SWALLOWING FUNCTION EVAL

Facility

$2,400.00

Service Code	HCPCS 92610GN
Hospital Charge Code	9000456
Hospital Revenue Code	444
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SP SWALLOWING FUNCTION EVAL

Facility

$2,400.00

Service Code	HCPCS 92610GN
Hospital Charge Code	9000456
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

SP TX OF SWALLOWNG DYSFUNCTION

Facility

$244.85

Service Code	HCPCS 92526GN
Hospital Charge Code	9000480
Hospital Revenue Code	440
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$36.73

SP TX OF SWALLOWNG DYSFUNCTION

Facility

$244.85

Service Code	HCPCS 92526GN
Hospital Charge Code	9000480
Hospital Revenue Code	440
Min. Negotiated Rate	$31.83
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.45
Rate for Payer: Aetna Medicare Advantage	$73.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.44
Rate for Payer: Cigna Commercial	$122.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.83
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.73
Rate for Payer: UnitedHealthcare Commercial	$686.00

SPUTUM AFB CULT SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479502
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

SPUTUM AFB CULT SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479502
Hospital Revenue Code	309
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$17.46
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: Cigna Medicare Advantage	$2.69
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.71
Rate for Payer: Wellcare Medicare Advantage	$5.39

SPUTUM CYTOLOGY

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	3005349
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SPUTUM CYTOLOGY

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	3005349
Hospital Revenue Code	311
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$47.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

SPUTUM INDUCEMENT SUBSEQUENT

Facility

$467.85

Service Code	HCPCS 94640
Hospital Charge Code	9500625
Hospital Revenue Code	410
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$70.18
Rate for Payer: Qualcare PPO/HMO/WC	$70.18

SPUTUM INDUCEMENT SUBSEQUENT

Facility

$467.85

Service Code	HCPCS 94640
Hospital Charge Code	9500625
Hospital Revenue Code	410
Min. Negotiated Rate	$42.55
Max. Negotiated Rate	$1,004.00
Rate for Payer: Aetna Commercial	$140.35
Rate for Payer: Aetna Medicare Advantage	$140.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.30
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.82
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.18
Rate for Payer: UnitedHealthcare Commercial	$1,004.00

SPY AGENT GREEN INDOCYANNE GRE

Facility

$1,364.72

Service Code	NDC 66259014601
Hospital Charge Code	606390601
Hospital Revenue Code	250
Min. Negotiated Rate	$177.41
Max. Negotiated Rate	$682.36
Rate for Payer: Aetna Commercial	$409.42
Rate for Payer: Aetna Medicare Advantage	$409.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.00
Rate for Payer: Cigna Commercial	$682.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.41
Rate for Payer: Oxford Commercial	$682.36
Rate for Payer: Qualcare PPO/HMO/WC	$204.71
Rate for Payer: UnitedHealthcare Commercial	$682.36

SPY AGENT GREEN INDOCYANNE GRE

Facility

$1,364.72

Service Code	NDC 66259014601
Hospital Charge Code	606390601
Hospital Revenue Code	250
Min. Negotiated Rate	$204.71
Max. Negotiated Rate	$204.71
Rate for Payer: Qualcare PPO/HMO/WC	$204.71

SPY SCOPE CATHETER DS II

Facility

$13,250.00

Hospital Charge Code	270689020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,722.50
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$3,975.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,722.50
Rate for Payer: Oxford Commercial	$6,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Commercial	$6,625.00

SPY SCOPE CATHETER DS II

Facility

$13,250.00

Hospital Charge Code	270689020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

SQ INC ACHILLES TNDN W LCL AN

Facility

$19,998.60

Service Code	HCPCS 27605
Hospital Charge Code	16000564
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

SQ INC ACHILLES TNDN W LCL AN

Facility

$19,998.60

Service Code	HCPCS 27605
Hospital Charge Code	16000564
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,999.58
Rate for Payer: Aetna Commercial	$5,999.58
Rate for Payer: Aetna Medicare Advantage	$5,999.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,099.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,099.64
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	$5,099.64
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,599.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

SQUAMOUSCELL CARCINOMA ANTIGEN

Facility

$415.00

Service Code	HCPCS 86316
Hospital Charge Code	38476208
Hospital Revenue Code	302
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$62.25
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

SQUAMOUSCELL CARCINOMA ANTIGEN

Facility

$415.00

Service Code	HCPCS 86316
Hospital Charge Code	38476208
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$67.42
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$20.81
Rate for Payer: Cigna Medicare Advantage	$10.40
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.06
Rate for Payer: Wellcare Medicare Advantage	$20.81

SQUARE DRIVER INSERT SDI

Facility

$178.65

Hospital Charge Code	270636610
Hospital Revenue Code	272
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$89.33
Rate for Payer: Aetna Commercial	$53.59
Rate for Payer: Aetna Medicare Advantage	$53.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.56
Rate for Payer: Cigna Commercial	$89.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.22
Rate for Payer: Oxford Commercial	$89.33
Rate for Payer: Qualcare PPO/HMO/WC	$26.80
Rate for Payer: UnitedHealthcare Commercial	$89.33

SQUARE DRIVER INSERT SDI

Facility

$178.65

Hospital Charge Code	270636610
Hospital Revenue Code	272
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$26.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.80

SREP F/E/N/L/MM; 2.5CM/<

Facility

$1,142.85

Service Code	HCPCS 12011
Hospital Charge Code	1600000665
Hospital Revenue Code	360
Min. Negotiated Rate	$171.43
Max. Negotiated Rate	$171.43
Rate for Payer: Qualcare PPO/HMO/WC	$171.43

SREP F/E/N/L/MM; 2.5CM/<

Facility

$1,142.85

Service Code	HCPCS 12011
Hospital Charge Code	1600000665
Hospital Revenue Code	360
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$342.86
Rate for Payer: Aetna Medicare Advantage	$342.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.43
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	$291.43
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.57
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.43
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges