Heights University Hospital

All Charges

Charge

Type

Setting

Price

TCM EXCISION BENIGN <1-2 CM

Facility

$1,049.00

Service Code	HCPCS 11402
Hospital Charge Code	93950017
Hospital Revenue Code	761
Min. Negotiated Rate	$65.09
Max. Negotiated Rate	$1,686.34
Rate for Payer: Aetna Commercial	$314.70
Rate for Payer: Aetna Medicare Advantage	$314.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.50
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.37
Rate for Payer: Oxford Commercial	$524.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$524.50

TCM EXCISION BENIGN 2-3 CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	93950019
Hospital Revenue Code	761
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$157.35

TCM EXCISION BENIGN 2-3 CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	93950019
Hospital Revenue Code	761
Min. Negotiated Rate	$122.85
Max. Negotiated Rate	$1,686.34
Rate for Payer: Aetna Commercial	$314.70
Rate for Payer: Aetna Medicare Advantage	$314.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.50
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.37
Rate for Payer: Oxford Commercial	$524.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$524.50

TCM EXCISION BENIGN 3-4 CM

Facility

$1,049.00

Service Code	HCPCS 11404
Hospital Charge Code	93950021
Hospital Revenue Code	761
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$314.70
Rate for Payer: Aetna Medicare Advantage	$314.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.50
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.37
Rate for Payer: Oxford Commercial	$524.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$524.50

TCM EXCISION BENIGN 3-4 CM

Facility

$1,049.00

Service Code	HCPCS 11404
Hospital Charge Code	93950021
Hospital Revenue Code	761
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$157.35

TCM EXCISION/PUNCH BX

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	93950013
Hospital Revenue Code	761
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Qualcare PPO/HMO/WC	$101.70

TCM EXCISION/PUNCH BX

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	93950013
Hospital Revenue Code	761
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$1,686.34
Rate for Payer: Aetna Commercial	$203.40
Rate for Payer: Aetna Medicare Advantage	$203.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.89
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.14
Rate for Payer: Oxford Commercial	$339.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.70
Rate for Payer: UnitedHealthcare Commercial	$339.00

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.33
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$5.04
Rate for Payer: Cigna Medicare Advantage	$2.52
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
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	$5.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.34
Rate for Payer: Wellcare Medicare Advantage	$5.04

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$75.15
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$75.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HEPATITUS B (PEDS)

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	93950109
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HEPATITUS B (PEDS)

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	93950109
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$38.40
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$33.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$99.32
Max. Negotiated Rate	$317.04
Rate for Payer: Aetna Commercial	$229.20
Rate for Payer: Aetna Medicare Advantage	$229.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.82
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.32
Rate for Payer: Qualcare PPO/HMO/WC	$114.60

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$114.60
Max. Negotiated Rate	$114.60
Rate for Payer: Qualcare PPO/HMO/WC	$114.60

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$154.56
Rate for Payer: Aetna Commercial	$60.90
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$154.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM I&D OF ABSCESS, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950005
Hospital Revenue Code	761
Min. Negotiated Rate	$29.34
Max. Negotiated Rate	$962.01
Rate for Payer: Aetna Better Health Medicaid	$943.15
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$305.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$305.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01

TCM I&D OF ABSCESS, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950005
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

TCM I&D, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950003
Hospital Revenue Code	761
Min. Negotiated Rate	$29.34
Max. Negotiated Rate	$962.01
Rate for Payer: Aetna Better Health Medicaid	$943.15
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$305.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$305.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01

TCM I&D, SIMPLE

Facility

$610.00

Service Code	HCPCS 10060
Hospital Charge Code	93950003
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$80.54
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$80.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$126.48
Rate for Payer: Aetna Commercial	$60.90
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$126.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

Know your out-of-pocket cost for care.

All Charges