Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT LOWER EXT W/ CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73701RT
Hospital Charge Code	2205304
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/ CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73701RT
Hospital Charge Code	2205304
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/O CNTRST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2250406
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT LOWER EXT W/O CNTRST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2250406
Hospital Revenue Code	352
Min. Negotiated Rate	$145.70
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$336.23
Rate for Payer: Aetna Medicare Advantage	$336.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$233.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.79
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.70
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/O CNTRST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205406
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT LOWER EXT W/O CNTRST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205406
Hospital Revenue Code	352
Min. Negotiated Rate	$145.70
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$336.23
Rate for Payer: Aetna Medicare Advantage	$336.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$233.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.79
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.70
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/O CONTRAST BIL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205434
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/O CONTRAST BIL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205434
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2200319
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2200319
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/O CONTRAST RGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2200196
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W/O CONTRAST RGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2200196
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT WO&W CONTRAST BI

Facility

$9,500.00

Service Code	HCPCS 7370250
Hospital Charge Code	404373702B
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT WO&W CONTRAST BI

Facility

$9,500.00

Service Code	HCPCS 7370250
Hospital Charge Code	404373702B
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT WO&W CONTRAST L

Facility

$9,500.00

Service Code	HCPCS 73702LT
Hospital Charge Code	404373702L
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT WO&W CONTRAST L

Facility

$9,500.00

Service Code	HCPCS 73702LT
Hospital Charge Code	404373702L
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT WO&W CONTRAST R

Facility

$9,500.00

Service Code	HCPCS 73702RT
Hospital Charge Code	404373702R
Hospital Revenue Code	352
Min. Negotiated Rate	$1,235.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT WO&W CONTRAST R

Facility

$9,500.00

Service Code	HCPCS 73702RT
Hospital Charge Code	404373702R
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W&W/O CNTRST BLTL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205405
Hospital Revenue Code	352
Min. Negotiated Rate	$470.65
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,086.12
Rate for Payer: Aetna Medicare Advantage	$1,086.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.20
Rate for Payer: Cigna Commercial	$1,810.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.65
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.06
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W&W/O CNTRST BLTL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205405
Hospital Revenue Code	352
Min. Negotiated Rate	$543.06
Max. Negotiated Rate	$543.06
Rate for Payer: Qualcare PPO/HMO/WC	$543.06

CT LOWER EXT W&W/O CNTRST RGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205308
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT LOWER EXT W&W/O CNTRST RGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205308
Hospital Revenue Code	352
Min. Negotiated Rate	$235.33
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$543.06
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$905.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W&W/O CONTRST LFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205306
Hospital Revenue Code	352
Min. Negotiated Rate	$235.33
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$543.06
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$905.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT LOWER EXT W&W/O CONTRST LFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205306
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT LUMBAR SPINE W/ C

Facility

$9,500.00

Service Code	HCPCS 72132
Hospital Charge Code	2200112
Hospital Revenue Code	352
Min. Negotiated Rate	$318.24
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Better Health Medicaid	$1,512.95
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,235.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,773.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21

Know your out-of-pocket cost for care.

All Charges