Heights University Hospital

All Charges

Charge

Type

Setting

Price

US OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$72.15
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$166.50
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.15
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
Hospital Revenue Code	402
Min. Negotiated Rate	$99.38
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US OB<14 WKS NUCHAL EA ADDTL

Facility

$373.90

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$56.09
Rate for Payer: Qualcare PPO/HMO/WC	$56.09

US OB<14 WKS NUCHAL EA ADDTL

Facility

$373.90

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$112.17
Rate for Payer: Aetna Medicare Advantage	$112.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.34
Rate for Payer: Cigna Commercial	$83.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.61
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.09
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US-OB DETAILED ADDL FETUS

Facility

$517.00

Hospital Charge Code	2309015
Hospital Revenue Code	402
Min. Negotiated Rate	$67.21
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$155.10
Rate for Payer: Aetna Medicare Advantage	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.84
Rate for Payer: Cigna Commercial	$258.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US-OB DETAILED ADDL FETUS

Facility

$517.00

Hospital Charge Code	2309015
Hospital Revenue Code	402
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

US-OB DETAILED SNGL FETUS

Facility

$1,754.00

Hospital Charge Code	2309010
Hospital Revenue Code	402
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$263.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.10

US-OB DETAILED SNGL FETUS

Facility

$1,754.00

Hospital Charge Code	2309010
Hospital Revenue Code	402
Min. Negotiated Rate	$228.02
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$526.20
Rate for Payer: Aetna Medicare Advantage	$526.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.27
Rate for Payer: Cigna Commercial	$877.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.02
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.10
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$77.70
Rate for Payer: Qualcare PPO/HMO/WC	$77.70

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$155.40
Rate for Payer: Aetna Medicare Advantage	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.09
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.34
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.70
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC A-SCAN BILATERAL

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301036
Hospital Revenue Code	402
Min. Negotiated Rate	$45.77
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$105.61
Rate for Payer: Aetna Medicare Advantage	$105.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.77
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.77
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC A-SCAN BILATERAL

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301036
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC A-SCAN LEFT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301040
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC A-SCAN LEFT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301040
Hospital Revenue Code	402
Min. Negotiated Rate	$45.77
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$105.61
Rate for Payer: Aetna Medicare Advantage	$105.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.77
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.77
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC A-SCAN RIGHT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301041
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC A-SCAN RIGHT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301041
Hospital Revenue Code	402
Min. Negotiated Rate	$45.77
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$105.61
Rate for Payer: Aetna Medicare Advantage	$105.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.77
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.77
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC B-SCAN BILATERAL

Facility

$563.15

Service Code	HCPCS 76512
Hospital Charge Code	2301045
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHALMIC B-SCAN BILATERAL

Facility

$563.15

Service Code	HCPCS 76512
Hospital Charge Code	2301045
Hospital Revenue Code	402
Min. Negotiated Rate	$73.21
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$168.94
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC B-SCAN LEFT

Facility

$563.15

Service Code	HCPCS 76512LT
Hospital Charge Code	2301049
Hospital Revenue Code	402
Min. Negotiated Rate	$73.21
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$168.94
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC B-SCAN LEFT

Facility

$563.15

Service Code	HCPCS 76512LT
Hospital Charge Code	2301049
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHALMIC B-SCAN RIGHT

Facility

$563.15

Service Code	HCPCS 76512RT
Hospital Charge Code	2301050
Hospital Revenue Code	402
Min. Negotiated Rate	$73.21
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$168.94
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.21
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US OPHTHALMIC B-SCAN RIGHT

Facility

$563.15

Service Code	HCPCS 76512RT
Hospital Charge Code	2301050
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHLMC A-SCAN INTCLR BLTL

Facility

$1,126.30

Service Code	HCPCS 7651950
Hospital Charge Code	2301037
Hospital Revenue Code	402
Min. Negotiated Rate	$168.94
Max. Negotiated Rate	$168.94
Rate for Payer: Qualcare PPO/HMO/WC	$168.94

US OPHTHLMC A-SCAN INTCLR BLTL

Facility

$1,126.30

Service Code	HCPCS 7651950
Hospital Charge Code	2301037
Hospital Revenue Code	402
Min. Negotiated Rate	$146.42
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$337.89
Rate for Payer: Aetna Medicare Advantage	$337.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.21
Rate for Payer: Cigna Commercial	$563.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.42
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.94
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

Know your out-of-pocket cost for care.

All Charges