Heights University Hospital

All Charges

Charge

Type

Setting

Price

STONE ANALYSIS INFRARED SPECT

Facility

$153.65

Service Code	HCPCS 82365
Hospital Charge Code	3004397
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.27
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: Cigna Medicare Advantage	$6.45
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.67
Rate for Payer: Wellcare Medicare Advantage	$12.90

STONE ANALYSIS, QUAL

Facility

$119.25

Service Code	HCPCS 82355
Hospital Charge Code	3005296
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

STONE ANALYSIS, QUAL

Facility

$119.25

Service Code	HCPCS 82355
Hospital Charge Code	3005296
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.52
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.43
Rate for Payer: Cigna Commercial	$11.58
Rate for Payer: Cigna Medicare Advantage	$5.79
Rate for Payer: Clover Medicare Advantage	$11.00
Rate for Payer: EmblemHealth Commercial	$34.74
Rate for Payer: Humana Medicare Advantage	$11.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.27
Rate for Payer: Wellcare Medicare Advantage	$11.58

STONE ANALYSIS, QUAL

Facility

$390.00

Service Code	HCPCS 82355
Hospital Charge Code	3005295
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STONE ANALYSIS, QUAL

Facility

$390.00

Service Code	HCPCS 82355
Hospital Charge Code	3005295
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.52
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.43
Rate for Payer: Cigna Commercial	$11.58
Rate for Payer: Cigna Medicare Advantage	$5.79
Rate for Payer: Clover Medicare Advantage	$11.00
Rate for Payer: EmblemHealth Commercial	$34.74
Rate for Payer: Humana Medicare Advantage	$11.93
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	$11.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.27
Rate for Payer: Wellcare Medicare Advantage	$11.58

STONE BASKET EXPAND 212 3 FR 9

Facility

$831.95

Hospital Charge Code	270682472
Hospital Revenue Code	272
Min. Negotiated Rate	$124.79
Max. Negotiated Rate	$124.79
Rate for Payer: Qualcare PPO/HMO/WC	$124.79

STONE BASKET EXPAND 212 3 FR 9

Facility

$831.95

Hospital Charge Code	270682472
Hospital Revenue Code	272
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$415.98
Rate for Payer: Aetna Commercial	$249.59
Rate for Payer: Aetna Medicare Advantage	$249.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.15
Rate for Payer: Cigna Commercial	$415.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.15
Rate for Payer: Oxford Commercial	$415.98
Rate for Payer: Qualcare PPO/HMO/WC	$124.79
Rate for Payer: UnitedHealthcare Commercial	$415.98

STONEBASKET G07313

Facility

$2,389.35

Hospital Charge Code	270635185
Hospital Revenue Code	272
Min. Negotiated Rate	$310.62
Max. Negotiated Rate	$1,194.67
Rate for Payer: Aetna Commercial	$716.80
Rate for Payer: Aetna Medicare Advantage	$716.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$609.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$609.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$609.28
Rate for Payer: Cigna Commercial	$1,194.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.62
Rate for Payer: Oxford Commercial	$1,194.67
Rate for Payer: Qualcare PPO/HMO/WC	$358.40
Rate for Payer: UnitedHealthcare Commercial	$1,194.67

STONEBASKET G07313

Facility

$2,198.75

Hospital Charge Code	270635185C
Hospital Revenue Code	272
Min. Negotiated Rate	$329.81
Max. Negotiated Rate	$329.81
Rate for Payer: Qualcare PPO/HMO/WC	$329.81

STONEBASKET G07313

Facility

$2,389.35

Hospital Charge Code	270635185
Hospital Revenue Code	272
Min. Negotiated Rate	$358.40
Max. Negotiated Rate	$358.40
Rate for Payer: Qualcare PPO/HMO/WC	$358.40

STONEBASKET G07313

Facility

$2,198.75

Hospital Charge Code	270635185C
Hospital Revenue Code	272
Min. Negotiated Rate	$285.84
Max. Negotiated Rate	$1,099.38
Rate for Payer: Aetna Commercial	$659.62
Rate for Payer: Aetna Medicare Advantage	$659.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$560.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$560.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$560.68
Rate for Payer: Cigna Commercial	$1,099.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.84
Rate for Payer: Oxford Commercial	$1,099.38
Rate for Payer: Qualcare PPO/HMO/WC	$329.81
Rate for Payer: UnitedHealthcare Commercial	$1,099.38

STONE CRYSTALOGRAPH***

Facility

$42.00

Service Code	HCPCS 82365
Hospital Charge Code	3030798
Hospital Revenue Code	309
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.27
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: Cigna Medicare Advantage	$6.45
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.67
Rate for Payer: Wellcare Medicare Advantage	$12.90

STONE CRYSTALOGRAPH***

Facility

$42.00

Service Code	HCPCS 82365
Hospital Charge Code	3030798
Hospital Revenue Code	309
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

STONETOME MCV 1 3511

Facility

$1,992.85

Hospital Charge Code	270604754
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 1 3511

Facility

$1,992.85

Hospital Charge Code	270604754
Hospital Revenue Code	270
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$597.86
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.07
Rate for Payer: Oxford Commercial	$996.42
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$996.42

STONETOME MCV 20MM 3521

Facility

$2,261.65

Hospital Charge Code	270615962
Hospital Revenue Code	272
Min. Negotiated Rate	$294.01
Max. Negotiated Rate	$1,130.83
Rate for Payer: Aetna Commercial	$678.50
Rate for Payer: Aetna Medicare Advantage	$678.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.72
Rate for Payer: Cigna Commercial	$1,130.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.01
Rate for Payer: Oxford Commercial	$1,130.83
Rate for Payer: Qualcare PPO/HMO/WC	$339.25
Rate for Payer: UnitedHealthcare Commercial	$1,130.83

STONETOME MCV 20MM 3521

Facility

$2,261.65

Hospital Charge Code	270615962
Hospital Revenue Code	272
Min. Negotiated Rate	$339.25
Max. Negotiated Rate	$339.25
Rate for Payer: Qualcare PPO/HMO/WC	$339.25

STONETOME MCV 20MM BALLN 3515

Facility

$1,992.85

Hospital Charge Code	270601180
Hospital Revenue Code	270
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$597.86
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.07
Rate for Payer: Oxford Commercial	$996.42
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$996.42

STONETOME MCV 20MM BALLN 3515

Facility

$1,992.85

Hospital Charge Code	270601180
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 2 3512

Facility

$1,992.85

Hospital Charge Code	270604755
Hospital Revenue Code	270
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$597.86
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.07
Rate for Payer: Oxford Commercial	$996.42
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$996.42

STONETOME MCV 2 3512

Facility

$1,992.85

Hospital Charge Code	270604755
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

STONETOME MCV 30MM BALLN 3519

Facility

$2,953.65

Hospital Charge Code	270601179
Hospital Revenue Code	270
Min. Negotiated Rate	$443.05
Max. Negotiated Rate	$443.05
Rate for Payer: Qualcare PPO/HMO/WC	$443.05

STONETOME MCV 30MM BALLN 3519

Facility

$2,953.65

Hospital Charge Code	270601179
Hospital Revenue Code	270
Min. Negotiated Rate	$383.97
Max. Negotiated Rate	$1,476.83
Rate for Payer: Aetna Commercial	$886.10
Rate for Payer: Aetna Medicare Advantage	$886.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$753.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$753.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$753.18
Rate for Payer: Cigna Commercial	$1,476.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.97
Rate for Payer: Oxford Commercial	$1,476.83
Rate for Payer: Qualcare PPO/HMO/WC	$443.05
Rate for Payer: UnitedHealthcare Commercial	$1,476.83

STONETOME MCV 3 3513

Facility

$1,992.85

Hospital Charge Code	270604756
Hospital Revenue Code	270
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$597.86
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.07
Rate for Payer: Oxford Commercial	$996.42
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Commercial	$996.42

STONETOME MCV 3 3513

Facility

$1,992.85

Hospital Charge Code	270604756
Hospital Revenue Code	270
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$298.93
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

Know your out-of-pocket cost for care.

All Charges