Heights University Hospital

All Charges

Charge

Type

Setting

Price

STEREOTACT GUIDE BRST BX-GL

Facility

$824.35

Hospital Charge Code	85000035
Hospital Revenue Code	320
Min. Negotiated Rate	$123.65
Max. Negotiated Rate	$123.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.65

STEREOTACT GUIDE BRST BX-GL

Facility

$824.35

Hospital Charge Code	85000035
Hospital Revenue Code	320
Min. Negotiated Rate	$107.17
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$247.31
Rate for Payer: Aetna Medicare Advantage	$247.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.21
Rate for Payer: Cigna Commercial	$412.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.17
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

STEREOTACT GUIDE BRST BX-PC

Facility

$424.95

Service Code	HCPCS 7703126
Hospital Charge Code	85000045
Hospital Revenue Code	320
Min. Negotiated Rate	$63.74
Max. Negotiated Rate	$63.74
Rate for Payer: Qualcare PPO/HMO/WC	$63.74

STEREOTACT GUIDE BRST BX-PC

Facility

$424.95

Service Code	HCPCS 7703126
Hospital Charge Code	85000045
Hospital Revenue Code	320
Min. Negotiated Rate	$55.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$127.48
Rate for Payer: Aetna Medicare Advantage	$127.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.36
Rate for Payer: Cigna Commercial	$212.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.74
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

STEREOTACT GUIDE BRST BX-TC

Facility

$399.40

Service Code	HCPCS 77031TC
Hospital Charge Code	85000040
Hospital Revenue Code	320
Min. Negotiated Rate	$51.92
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$119.82
Rate for Payer: Aetna Medicare Advantage	$119.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.85
Rate for Payer: Cigna Commercial	$199.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.92
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.91
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

STEREOTACT GUIDE BRST BX-TC

Facility

$399.40

Service Code	HCPCS 77031TC
Hospital Charge Code	85000040
Hospital Revenue Code	320
Min. Negotiated Rate	$59.91
Max. Negotiated Rate	$59.91
Rate for Payer: Qualcare PPO/HMO/WC	$59.91

STEREOTACTIC BREAST BIOPSY

Facility

$4,089.00

Service Code	HCPCS 19081
Hospital Charge Code	2300913
Hospital Revenue Code	361
Min. Negotiated Rate	$613.35
Max. Negotiated Rate	$613.35
Rate for Payer: Qualcare PPO/HMO/WC	$613.35

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	87502806
Hospital Revenue Code	361
Min. Negotiated Rate	$400.35
Max. Negotiated Rate	$400.35
Rate for Payer: Qualcare PPO/HMO/WC	$400.35

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2008035
Hospital Revenue Code	361
Min. Negotiated Rate	$400.35
Max. Negotiated Rate	$400.35
Rate for Payer: Qualcare PPO/HMO/WC	$400.35

STEREOTACTIC BREAST BIOPSY

Facility

$4,089.00

Service Code	HCPCS 19081
Hospital Charge Code	2300913
Hospital Revenue Code	361
Min. Negotiated Rate	$531.57
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,226.70
Rate for Payer: Aetna Medicare Advantage	$1,226.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.69
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	$1,042.69
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.57
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.35
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2008035
Hospital Revenue Code	361
Min. Negotiated Rate	$346.97
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$800.70
Rate for Payer: Aetna Medicare Advantage	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$680.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$680.60
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	$680.60
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.97
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$400.35
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	87502806
Hospital Revenue Code	361
Min. Negotiated Rate	$346.97
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$800.70
Rate for Payer: Aetna Medicare Advantage	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$680.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$680.60
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	$680.60
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.97
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$400.35
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

STEREOTACTIC BREAST LOCALIZATI

Facility

$1,597.20

Service Code	HCPCS 19283
Hospital Charge Code	2700026
Hospital Revenue Code	361
Min. Negotiated Rate	$239.58
Max. Negotiated Rate	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$239.58

STEREOTACTIC BREAST LOCALIZATI

Facility

$1,597.20

Service Code	HCPCS 19283
Hospital Charge Code	2700026
Hospital Revenue Code	361
Min. Negotiated Rate	$207.64
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$479.16
Rate for Payer: Aetna Medicare Advantage	$479.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$407.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$407.29
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	$407.29
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.64
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.58
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

STEREOTACT RADIATION TRMT

Facility

$2,164.65

Service Code	HCPCS 77432
Hospital Charge Code	85000790
Hospital Revenue Code	333
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$649.39
Rate for Payer: Aetna Medicare Advantage	$649.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.99
Rate for Payer: Cigna Commercial	$465.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.40
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.70
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

STEREOTACT RADIATION TRMT

Facility

$2,164.65

Service Code	HCPCS 77432
Hospital Charge Code	85000790
Hospital Revenue Code	333
Min. Negotiated Rate	$324.70
Max. Negotiated Rate	$324.70
Rate for Payer: Qualcare PPO/HMO/WC	$324.70

STERI-CUFF DISP********

Facility

$108.00

Hospital Charge Code	1605971
Hospital Revenue Code	272
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$32.40
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$54.00

STERI-CUFF DISP********

Facility

$108.00

Hospital Charge Code	1605971
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

STERI DRAPE 2037

Facility

$15.17

Hospital Charge Code	270610068
Hospital Revenue Code	272
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.28

STERI DRAPE 2037

Facility

$15.17

Hospital Charge Code	270610068
Hospital Revenue Code	272
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$7.58
Rate for Payer: Aetna Commercial	$4.55
Rate for Payer: Aetna Medicare Advantage	$4.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.87
Rate for Payer: Cigna Commercial	$7.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.97
Rate for Payer: Oxford Commercial	$7.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.28
Rate for Payer: UnitedHealthcare Commercial	$7.58

STERILE BARIUM SULFATE 50ML

Facility

$157.00

Hospital Charge Code	270335722
Hospital Revenue Code	272
Min. Negotiated Rate	$20.41
Max. Negotiated Rate	$78.50
Rate for Payer: Aetna Commercial	$47.10
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.41
Rate for Payer: Oxford Commercial	$78.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$78.50

STERILE BARIUM SULFATE 50ML

Facility

$157.00

Hospital Charge Code	270335722
Hospital Revenue Code	272
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

STERILE DISPOSABLE DRAIN BAG

Facility

$95.00

Hospital Charge Code	270330543
Hospital Revenue Code	272
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$47.50

STERILE DISPOSABLE DRAIN BAG

Facility

$95.00

Hospital Charge Code	270330543
Hospital Revenue Code	272
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

STERILE GOWN SIZE LARGE

Facility

$12.50

Hospital Charge Code	270653946
Hospital Revenue Code	270
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$3.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$6.25

Know your out-of-pocket cost for care.

All Charges