Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$10.35
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

TCM SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
Hospital Revenue Code	510
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$47.66
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	$47.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

TCM SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$76.23
Rate for Payer: Aetna Commercial	$52.20
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$76.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
Hospital Revenue Code	510
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$115.66
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	$115.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM SUTURE/STAPLE REMOVAL

Facility

$125.00

Service Code	HCPCS 17999
Hospital Charge Code	93950029
Hospital Revenue Code	761
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

TCM SUTURE/STAPLE REMOVAL

Facility

$125.00

Service Code	HCPCS 17999
Hospital Charge Code	93950029
Hospital Revenue Code	761
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

TCM TD (ADULT) IM

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950097
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM TD (ADULT) IM

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950097
Hospital Revenue Code	250
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.83
Rate for Payer: Oxford Commercial	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$45.50

TCM TDAP

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	93950093
Hospital Revenue Code	636
Min. Negotiated Rate	$437.01
Max. Negotiated Rate	$705.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01

TCM TDAP

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	93950093
Hospital Revenue Code	636
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$874.02
Rate for Payer: Aetna Commercial	$874.02
Rate for Payer: Aetna Medicare Advantage	$874.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.92
Rate for Payer: Cigna Commercial	$39.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01

TCM TD IM >7

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950099
Hospital Revenue Code	250
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.83
Rate for Payer: Oxford Commercial	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$45.50

TCM TD IM >7

Facility

$91.00

Service Code	HCPCS 90718
Hospital Charge Code	93950099
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM TRIGGER POINT INJCTION >2

Facility

$242.00

Service Code	HCPCS 20553
Hospital Charge Code	93950035
Hospital Revenue Code	761
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

TCM TRIGGER POINT INJCTION >2

Facility

$242.00

Service Code	HCPCS 20553
Hospital Charge Code	93950035
Hospital Revenue Code	761
Min. Negotiated Rate	$31.13
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$72.60
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Oxford Commercial	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$121.00

TCM TRIGGER POINT INJCTON 1-2

Facility

$121.00

Service Code	HCPCS 20552
Hospital Charge Code	93950033
Hospital Revenue Code	761
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$730.97
Rate for Payer: Aetna Commercial	$36.30
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.73
Rate for Payer: Oxford Commercial	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$60.50

TCM TRIGGER POINT INJCTON 1-2

Facility

$121.00

Service Code	HCPCS 20552
Hospital Charge Code	93950033
Hospital Revenue Code	761
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

TCM URINE DIPSTICK

Facility

$103.00

Service Code	HCPCS 81000
Hospital Charge Code	93950049
Hospital Revenue Code	307
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.73
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: Cigna Medicare Advantage	$2.01
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.26
Rate for Payer: Wellcare Medicare Advantage	$4.02

TCM URINE DIPSTICK

Facility

$103.00

Service Code	HCPCS 81000
Hospital Charge Code	93950049
Hospital Revenue Code	307
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCM URINE PREGNANCY

Facility

$414.00

Service Code	HCPCS 81025
Hospital Charge Code	93950051
Hospital Revenue Code	307
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$114.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Aetna Commercial	$27.90
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: Cigna Medicare Advantage	$4.30
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.13
Rate for Payer: Wellcare Medicare Advantage	$8.61

TCM URINE PREGNANCY

Facility

$414.00

Service Code	HCPCS 81025
Hospital Charge Code	93950051
Hospital Revenue Code	307
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

Know your out-of-pocket cost for care.

All Charges