Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$54.10
Rate for Payer: Aetna Medicare Advantage	$54.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.99
Rate for Payer: Cigna Commercial	$90.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.45
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.05
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$27.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.05

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	94064039
Hospital Revenue Code	401
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$54.10
Rate for Payer: Aetna Medicare Advantage	$54.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.99
Rate for Payer: Cigna Commercial	$90.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.45
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.05
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	94064039
Hospital Revenue Code	401
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$27.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.05

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	94064041
Hospital Revenue Code	403
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	94064041
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011240
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011270
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011240
Hospital Revenue Code	403
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011270
Hospital Revenue Code	403
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$39.27
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	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$830.80
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 CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DACRYOCYSTOGRAPHY

Facility

$1,224.75

Service Code	HCPCS 70170
Hospital Charge Code	2011328
Hospital Revenue Code	320
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR DACRYOCYSTOGRAPHY

Facility

$1,224.75

Service Code	HCPCS 70170
Hospital Charge Code	2011328
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	7411474
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	7411474
Hospital Revenue Code	361
Min. Negotiated Rate	$144.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$334.15
Rate for Payer: Aetna Medicare Advantage	$334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.03
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	$284.03
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	321036593
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	411036593
Hospital Revenue Code	361
Min. Negotiated Rate	$223.16
Max. Negotiated Rate	$223.16
Rate for Payer: Qualcare PPO/HMO/WC	$223.16

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	366836593
Hospital Revenue Code	361
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$446.31
Rate for Payer: Aetna Medicare Advantage	$446.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.36
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	$379.36
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.16
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	5600137
Hospital Revenue Code	361
Min. Negotiated Rate	$786.58
Max. Negotiated Rate	$4,640.55
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	366836593
Hospital Revenue Code	361
Min. Negotiated Rate	$223.16
Max. Negotiated Rate	$223.16
Rate for Payer: Qualcare PPO/HMO/WC	$223.16

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	411036593
Hospital Revenue Code	361
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$446.31
Rate for Payer: Aetna Medicare Advantage	$446.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.36
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	$379.36
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.16
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	5600137
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

Know your out-of-pocket cost for care.

All Charges