Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT LUMBAR SPINE W/ C

Facility

$9,500.00

Service Code	HCPCS 72132
Hospital Charge Code	2200112
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 LUMBAR SPINE WO C

Facility

$9,500.00

Service Code	HCPCS 72131
Hospital Charge Code	2200111
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 LUMBAR SPINE WO C

Facility

$9,500.00

Service Code	HCPCS 72131
Hospital Charge Code	2200111
Hospital Revenue Code	352
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
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) NJ Health	$272.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
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 LUMBAR SPINE W/O & W/ C

Facility

$9,500.00

Service Code	HCPCS 72133
Hospital Charge Code	2200113
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 LUMBAR SPINE W/O & W/ C

Facility

$9,500.00

Service Code	HCPCS 72133
Hospital Charge Code	2200113
Hospital Revenue Code	352
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Better Health Medicaid	$940.08
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	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
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	$958.88

CT Mandible w/o Contrast

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200277
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT Mandible w/o Contrast

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200277
Hospital Revenue Code	351
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
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) NJ Health	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
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 MANDIBLE WO & W CONT

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200276
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT MANDIBLE WO & W CONT

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200276
Hospital Revenue Code	351
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
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) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
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 MANDIBLE W/O + W CONTRAST

Facility

$1,217.65

Service Code	HCPCS 70487
Hospital Charge Code	2200278
Hospital Revenue Code	351
Min. Negotiated Rate	$182.65
Max. Negotiated Rate	$182.65
Rate for Payer: Qualcare PPO/HMO/WC	$182.65

CT MANDIBLE W/O + W CONTRAST

Facility

$1,217.65

Service Code	HCPCS 70487
Hospital Charge Code	2200278
Hospital Revenue Code	351
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$365.30
Rate for Payer: Aetna Medicare Advantage	$365.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.50
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	$310.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.29
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.65
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT MASTOID W CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70481
Hospital Charge Code	2250421
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT MASTOID W CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70481
Hospital Charge Code	2250421
Hospital Revenue Code	351
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$2,850.00
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) NJ Health	$233.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
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 MASTOID W/O CONTRST

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2250420
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT MASTOID W/O CONTRST

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2250420
Hospital Revenue Code	351
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
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) NJ Health	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
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 MAXILLO FACIAL AREA WO C

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200327
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT MAXILLO FACIAL AREA WO C

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200327
Hospital Revenue Code	351
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$2,850.00
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) NJ Health	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$248.96
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 MAXILLO FACIAL AREA W/WO C

Facility

$1,217.65

Service Code	HCPCS 70487
Hospital Charge Code	2202328
Hospital Revenue Code	351
Min. Negotiated Rate	$182.65
Max. Negotiated Rate	$182.65
Rate for Payer: Qualcare PPO/HMO/WC	$182.65

CT MAXILLO FACIAL AREA W/WO C

Facility

$1,217.65

Service Code	HCPCS 70487
Hospital Charge Code	2202328
Hospital Revenue Code	351
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$365.30
Rate for Payer: Aetna Medicare Advantage	$365.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.50
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	$310.50
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.29
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.65
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT MAXILLOFACIAL W/ CONTRAST

Facility

$5,288.50

Service Code	HCPCS 70487
Hospital Charge Code	2205408
Hospital Revenue Code	351
Min. Negotiated Rate	$793.27
Max. Negotiated Rate	$793.27
Rate for Payer: Qualcare PPO/HMO/WC	$793.27

CT MAXILLOFACIAL W/ CONTRAST

Facility

$5,288.50

Service Code	HCPCS 70487
Hospital Charge Code	2205408
Hospital Revenue Code	351
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,586.55
Rate for Payer: Aetna Medicare Advantage	$1,586.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,348.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,348.57
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	$1,348.57
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$687.50
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$793.27
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT MAXILLOFACIAL W/O CONTRAST

Facility

$1,120.75

Service Code	HCPCS 70486
Hospital Charge Code	2205409
Hospital Revenue Code	351
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	$257.12
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 MAXILLOFACIAL W/O CONTRAST

Facility

$1,120.75

Service Code	HCPCS 70486
Hospital Charge Code	2205409
Hospital Revenue Code	351
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT MAXILLOFACIAL WO & W

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200329
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT MAXILLOFACIAL WO & W

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200329
Hospital Revenue Code	351
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$2,850.00
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) NJ Health	$327.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$417.70
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

Know your out-of-pocket cost for care.

All Charges