Heights University Hospital

All Charges

Charge

Type

Setting

Price

CT SELLA

Facility

$5,288.50

Service Code	HCPCS 70482
Hospital Charge Code	2205483
Hospital Revenue Code	351
Min. Negotiated Rate	$327.25
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	$327.25
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 SELLA TUCICA WO C

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200293
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 SELLA TUCICA WO C

Facility

$9,500.00

Service Code	HCPCS 70480
Hospital Charge Code	2200293
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 SHOULDER W/ CONTRAST BLTRAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205419
Hospital Revenue Code	352
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$533.05
Rate for Payer: Qualcare PPO/HMO/WC	$533.05

CT SHOULDER W/ CONTRAST BLTRAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205419
Hospital Revenue Code	352
Min. Negotiated Rate	$461.98
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,066.11
Rate for Payer: Aetna Medicare Advantage	$1,066.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.19
Rate for Payer: Cigna Commercial	$1,776.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.98
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$533.05
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SHOULDER W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205420
Hospital Revenue Code	352
Min. Negotiated Rate	$230.99
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$533.05
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.99
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SHOULDER W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205420
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT SHOULDER W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205421
Hospital Revenue Code	352
Min. Negotiated Rate	$230.99
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$533.05
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.99
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SHOULDER W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205421
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT SHOULDER W/O CNTRST BILTRAL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205422
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 SHOULDER W/O CNTRST BILTRAL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205422
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT SHOULDER W/O CONTRST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205423
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 SHOULDER W/O CONTRST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205423
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT SHOULDER W/O CONTRST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205424
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT SHOULDER W/O CONTRST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205424
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 SHOULDER W/&W/O CNTRST BLTL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205416
Hospital Revenue Code	352
Min. Negotiated Rate	$553.92
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$1,278.27
Rate for Payer: Aetna Medicare Advantage	$1,278.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,086.53
Rate for Payer: Cigna Commercial	$2,130.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.92
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$639.13
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SHOULDER W/&W/O CNTRST BLTL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205416
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT SHOULDER W/&W/O CNTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205418
Hospital Revenue Code	352
Min. Negotiated Rate	$276.96
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$639.13
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.96
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SHOULDER W/&W/O CNTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205418
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT SHOULDER W/&W/O CONTRST LFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205417
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT SHOULDER W/&W/O CONTRST LFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205417
Hospital Revenue Code	352
Min. Negotiated Rate	$276.96
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$639.13
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.96
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

CT SINUSES W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200269
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 SINUSES W/O CONTRAST

Facility

$9,500.00

Service Code	HCPCS 70486
Hospital Charge Code	2200269
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 SINUSES WO & W CONT

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200271
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 SINUSES WO & W CONT

Facility

$9,500.00

Service Code	HCPCS 70488
Hospital Charge Code	2200271
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

Know your out-of-pocket cost for care.

All Charges