Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR BREAST NEEDLE LOC EA ADD'Ly

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002517
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

XR BREAST NEEDLE LOC EA ADD'Ly

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002517
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR BREAST PLACE LOC WIRE INIT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

XR BREAST PLACE LOC WIRE INIT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$386.72
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$892.42
Rate for Payer: Aetna Medicare Advantage	$892.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.56
Rate for Payer: Cigna Commercial	$1,487.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$892.42
Rate for Payer: Aetna Medicare Advantage	$892.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.56
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN LT CHARGE

Facility

$497.65

Service Code	HCPCS 76098
Hospital Charge Code	2000930
Hospital Revenue Code	320
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$74.65
Rate for Payer: Qualcare PPO/HMO/WC	$74.65

XR BREAST SPECIMEN LT CHARGE

Facility

$497.65

Service Code	HCPCS 76098
Hospital Charge Code	2000930
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$149.29
Rate for Payer: Aetna Medicare Advantage	$149.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.90
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN RT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002286
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$892.42
Rate for Payer: Aetna Medicare Advantage	$892.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.56
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN RT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002286
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN RT CHARGE

Facility

$2,318.20

Service Code	HCPCS 76098
Hospital Charge Code	2000928
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Qualcare PPO/HMO/WC	$347.73
Rate for Payer: Aetna Commercial	$695.46
Rate for Payer: Aetna Medicare Advantage	$695.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.14
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.37
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BREAST SPECIMEN RT CHARGE

Facility

$2,318.20

Service Code	HCPCS 76098
Hospital Charge Code	2000928
Hospital Revenue Code	320
Min. Negotiated Rate	$347.73
Max. Negotiated Rate	$347.73
Rate for Payer: Qualcare PPO/HMO/WC	$347.73

XR BRONCHOGRAM BI

Facility

$375.00

Service Code	HCPCS 71060
Hospital Charge Code	2000594
Hospital Revenue Code	329
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BRONCHOGRAM BI

Facility

$375.00

Service Code	HCPCS 71060
Hospital Charge Code	2000594
Hospital Revenue Code	329
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

XR BRONCHOGRAM UNI

Facility

$481.65

Hospital Charge Code	2000586
Hospital Revenue Code	320
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$72.25
Rate for Payer: Qualcare PPO/HMO/WC	$72.25

XR BRONCHOGRAM UNI

Facility

$481.65

Hospital Charge Code	2000586
Hospital Revenue Code	320
Min. Negotiated Rate	$62.61
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$144.50
Rate for Payer: Aetna Medicare Advantage	$144.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.82
Rate for Payer: Cigna Commercial	$240.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BRONCHOGRAPHY BILATERAL

Facility

$602.00

Service Code	HCPCS 71060
Hospital Charge Code	2011311
Hospital Revenue Code	320
Min. Negotiated Rate	$78.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BRONCHOGRAPHY BILATERAL

Facility

$602.00

Service Code	HCPCS 71060
Hospital Charge Code	2011311
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR BRONCHOGRAPHY RIGHT

Facility

$602.00

Service Code	HCPCS 71040
Hospital Charge Code	2011312
Hospital Revenue Code	320
Min. Negotiated Rate	$78.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BRONCHOGRAPHY RIGHT

Facility

$602.00

Service Code	HCPCS 71040
Hospital Charge Code	2011312
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR BRONCHOSCOPY INJ FOR XRAY

Facility

$2,480.00

Hospital Charge Code	2011230
Hospital Revenue Code	361
Min. Negotiated Rate	$322.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$744.00
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
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	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.40
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

Know your out-of-pocket cost for care.

All Charges