Heights University Hospital

All Charges

Charge

Type

Setting

Price

TCM PREVENTIVE NEW PAT 65+YRS

Facility

$175.00

Service Code	HCPCS 99387
Hospital Charge Code	93950185
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE NEW PAT 65+YRS

Facility

$175.00

Service Code	HCPCS 99387
Hospital Charge Code	93950185
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE NEW PT 1-4 YRS

Facility

$175.00

Service Code	HCPCS 99382
Hospital Charge Code	93950175
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE NEW PT 1-4 YRS

Facility

$175.00

Service Code	HCPCS 99382
Hospital Charge Code	93950175
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE NEW PT <1 YEAR

Facility

$175.00

Service Code	HCPCS 99381
Hospital Charge Code	93950173
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE NEW PT <1 YEAR

Facility

$175.00

Service Code	HCPCS 99381
Hospital Charge Code	93950173
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTIVE NEW PT 5-11 YRS

Facility

$175.00

Service Code	HCPCS 99383
Hospital Charge Code	93950177
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTIVE NEW PT 5-11 YRS

Facility

$175.00

Service Code	HCPCS 99383
Hospital Charge Code	93950177
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	93950193
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	93950193
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	93950179
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	93950179
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM RAPID STREP

Facility

$125.00

Service Code	HCPCS 87880
Hospital Charge Code	93950059
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

TCM RAPID STREP

Facility

$125.00

Service Code	HCPCS 87880
Hospital Charge Code	93950059
Hospital Revenue Code	306
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.56
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.57
Rate for Payer: Cigna Commercial	$16.53
Rate for Payer: Cigna Medicare Advantage	$8.27
Rate for Payer: Clover Medicare Advantage	$15.70
Rate for Payer: EmblemHealth Commercial	$49.59
Rate for Payer: Humana Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.52
Rate for Payer: Wellcare Medicare Advantage	$16.53

TCM REMOVAL OF FOREIGN BODY

Facility

$475.00

Service Code	HCPCS 28190
Hospital Charge Code	93950041
Hospital Revenue Code	361
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

TCM REMOVAL OF FOREIGN BODY

Facility

$475.00

Service Code	HCPCS 28190
Hospital Charge Code	93950041
Hospital Revenue Code	361
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
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	$121.12
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.75
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

TCM REMOVE SKIN TAG ECH AD 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	93950011
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

Know your out-of-pocket cost for care.

All Charges