Heights University Hospital

All Charges

Charge

Type

Setting

Price

VENOUS DUPLEX SCAN UP EXT RT

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692210
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

VENOUS DUPLEX SCAN UP EXT RT

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	74117063
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

VENOUS MAPPING BILAT LE

Facility

$1,194.00

Service Code	HCPCS 9397050
Hospital Charge Code	2692070
Hospital Revenue Code	921
Min. Negotiated Rate	$179.10
Max. Negotiated Rate	$179.10
Rate for Payer: Qualcare PPO/HMO/WC	$179.10

VENOUS MAPPING BILAT LE

Facility

$1,194.00

Service Code	HCPCS 9397050
Hospital Charge Code	7411846
Hospital Revenue Code	921
Min. Negotiated Rate	$155.22
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$358.20
Rate for Payer: Aetna Medicare Advantage	$358.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.47
Rate for Payer: Cigna Commercial	$597.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.22
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.10
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING BILAT LE

Facility

$1,194.00

Service Code	HCPCS 9397050
Hospital Charge Code	7411846
Hospital Revenue Code	921
Min. Negotiated Rate	$179.10
Max. Negotiated Rate	$179.10
Rate for Payer: Qualcare PPO/HMO/WC	$179.10

VENOUS MAPPING BILAT LE

Facility

$1,194.00

Service Code	HCPCS 9397050
Hospital Charge Code	2692070
Hospital Revenue Code	921
Min. Negotiated Rate	$155.22
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$358.20
Rate for Payer: Aetna Medicare Advantage	$358.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.47
Rate for Payer: Cigna Commercial	$597.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.22
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.10
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT BI

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	74115046
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

VENOUS MAPPING LOWER EXT BI

Facility

$2,906.28

Service Code	HCPCS 93970
Hospital Charge Code	74117046
Hospital Revenue Code	921
Min. Negotiated Rate	$377.82
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$871.88
Rate for Payer: Aetna Medicare Advantage	$871.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$741.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$741.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$518.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$741.10
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.82
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.94
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT BI

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	2692215
Hospital Revenue Code	921
Min. Negotiated Rate	$518.65
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	$518.65
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

VENOUS MAPPING LOWER EXT BI

Facility

$2,906.28

Service Code	HCPCS 93970
Hospital Charge Code	74116046
Hospital Revenue Code	921
Min. Negotiated Rate	$377.82
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$871.88
Rate for Payer: Aetna Medicare Advantage	$871.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$741.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$741.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$518.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$741.10
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.82
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.94
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT BI

Facility

$2,906.28

Service Code	HCPCS 93970
Hospital Charge Code	74116046
Hospital Revenue Code	921
Min. Negotiated Rate	$435.94
Max. Negotiated Rate	$435.94
Rate for Payer: Qualcare PPO/HMO/WC	$435.94

VENOUS MAPPING LOWER EXT BI

Facility

$2,906.28

Service Code	HCPCS 93970
Hospital Charge Code	74117046
Hospital Revenue Code	921
Min. Negotiated Rate	$435.94
Max. Negotiated Rate	$435.94
Rate for Payer: Qualcare PPO/HMO/WC	$435.94

VENOUS MAPPING LOWER EXT BI

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	2692215
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

VENOUS MAPPING LOWER EXT BI

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	74115046
Hospital Revenue Code	921
Min. Negotiated Rate	$518.65
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	$518.65
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

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74116064
Hospital Revenue Code	921
Min. Negotiated Rate	$102.57
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74116064
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74115064
Hospital Revenue Code	921
Min. Negotiated Rate	$102.57
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74115064
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74117064
Hospital Revenue Code	921
Min. Negotiated Rate	$102.57
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING LOWER EXT RT

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74117064
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

VENOUS MAPPING LOWER EXT RT

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692220
Hospital Revenue Code	921
Min. Negotiated Rate	$248.96
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	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$248.96
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

VENOUS MAPPING LOWER EXT RT

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692220
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

VENOUS MAPPING OF LEFT LE

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692075
Hospital Revenue Code	921
Min. Negotiated Rate	$248.96
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	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$248.96
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

VENOUS MAPPING OF LEFT LE

Facility

$789.00

Service Code	HCPCS 93971
Hospital Charge Code	74115058
Hospital Revenue Code	921
Min. Negotiated Rate	$102.57
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

VENOUS MAPPING OF LEFT LE

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	2692075
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

Know your out-of-pocket cost for care.

All Charges