Heights University Hospital

All Charges

Charge

Type

Setting

Price

US PELVIS DUPLEX COMPLETE

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	2101108
Hospital Revenue Code	921
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

US PELVIS TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	2100279
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 PELVIS TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	2100279
Hospital Revenue Code	402
Min. Negotiated Rate	$137.82
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	$137.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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 PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	2101138
Hospital Revenue Code	402
Min. Negotiated Rate	$82.28
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
Hospital Revenue Code	402
Min. Negotiated Rate	$82.28
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
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 PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	2101138
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 PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

US PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERC RENAL CYST ASP RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2101197
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERC RENAL CYST ASP RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2101197
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	2100527
Hospital Revenue Code	361
Min. Negotiated Rate	$394.79
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$911.05
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$394.79
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	2100527
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS SUBSEQUE

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	2100535
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS SUBSEQUE

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	2100535
Hospital Revenue Code	361
Min. Negotiated Rate	$394.79
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$911.05
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$394.79
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	74110027
Hospital Revenue Code	402
Min. Negotiated Rate	$111.70
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$257.77
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.70
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	5100227
Hospital Revenue Code	402
Min. Negotiated Rate	$111.70
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$257.77
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.70
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	5100227
Hospital Revenue Code	402
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$128.89
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	74110027
Hospital Revenue Code	402
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$128.89
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

US PLACENTA LOCALIZ

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100089
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
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	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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 PLACENTA LOCALIZ

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100089
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 PLEURAL EFFUSION

Facility

$6,700.00

Service Code	HCPCS 76604
Hospital Charge Code	2100097
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
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	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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 PLEURAL EFFUSION

Facility

$6,700.00

Service Code	HCPCS 76604
Hospital Charge Code	2100097
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 - POPLITEAL-BIL

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	94061183
Hospital Revenue Code	402
Min. Negotiated Rate	$95.44
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	$95.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
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 - POPLITEAL-BIL

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	94061183
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

Know your out-of-pocket cost for care.

All Charges