Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX ER LOW EXT INFANT LT

Facility

$250.00

Service Code	HCPCS 73592LT
Hospital Charge Code	94270211
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER LOW EXT INFANT LT

Facility

$250.00

Service Code	HCPCS 73592LT
Hospital Charge Code	94270211
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER LOW EXT INFANT RT

Facility

$250.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94270213
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER LOW EXT INFANT RT

Facility

$250.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94270213
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER LOW LEG/TIB/FIB LT

Facility

$306.00

Service Code	HCPCS 73590LT
Hospital Charge Code	94270207
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

DX ER LOW LEG/TIB/FIB LT

Facility

$306.00

Service Code	HCPCS 73590LT
Hospital Charge Code	94270207
Hospital Revenue Code	320
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER LOW LEG/TIB/FIB RT

Facility

$306.00

Service Code	HCPCS 73590RT
Hospital Charge Code	94270209
Hospital Revenue Code	320
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER LOW LEG/TIB/FIB RT

Facility

$306.00

Service Code	HCPCS 73590RT
Hospital Charge Code	94270209
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

DX ER LUMBAR SPINE 2 3VWS

Facility

$1,275.40

Service Code	HCPCS 72100
Hospital Charge Code	94270045
Hospital Revenue Code	320
Min. Negotiated Rate	$41.14
Max. Negotiated Rate	$1,489.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$382.62
Rate for Payer: Aetna Medicare Advantage	$382.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.23
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.80
Rate for Payer: Qualcare PPO/HMO/WC	$191.31
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER LUMBAR SPINE 2 3VWS

Facility

$1,275.40

Service Code	HCPCS 72100
Hospital Charge Code	94270045
Hospital Revenue Code	320
Min. Negotiated Rate	$191.31
Max. Negotiated Rate	$191.31
Rate for Payer: Qualcare PPO/HMO/WC	$191.31

DX ER LUMBOSACRAL SPINE C

Facility

$765.00

Service Code	HCPCS 72110
Hospital Charge Code	94270047
Hospital Revenue Code	320
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

DX ER LUMBOSACRAL SPINE C

Facility

$765.00

Service Code	HCPCS 72110
Hospital Charge Code	94270047
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER MANDIBLE 4 VWS

Facility

$631.00

Service Code	HCPCS 70110
Hospital Charge Code	94270001
Hospital Revenue Code	320
Min. Negotiated Rate	$94.65
Max. Negotiated Rate	$94.65
Rate for Payer: Qualcare PPO/HMO/WC	$94.65

DX ER MANDIBLE 4 VWS

Facility

$631.00

Service Code	HCPCS 70110
Hospital Charge Code	94270001
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,627.00
Rate for Payer: Aetna Better Health Medicaid	$1,595.10
Rate for Payer: Aetna Commercial	$189.30
Rate for Payer: Aetna Medicare Advantage	$189.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.91
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.03
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00

DX ER NASAL BONES 3 VWS

Facility

$450.00

Service Code	HCPCS 70160
Hospital Charge Code	94270007
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX ER NASAL BONES 3 VWS

Facility

$450.00

Service Code	HCPCS 70160
Hospital Charge Code	94270007
Hospital Revenue Code	320
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

DX ER NECK SOFT TISSUES

Facility

$329.00

Service Code	HCPCS 70360
Hospital Charge Code	94270021
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

DX ER NECK SOFT TISSUES

Facility

$329.00

Service Code	HCPCS 70360
Hospital Charge Code	94270021
Hospital Revenue Code	320
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$98.70
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX ER ORBITS COMPLETE BIL

Facility

$250.00

Service Code	HCPCS 7020050
Hospital Charge Code	94270071
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER ORBITS COMPLETE BIL

Facility

$250.00

Service Code	HCPCS 7020050
Hospital Charge Code	94270071
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER ORBITS COMPLETE LT

Facility

$660.00

Service Code	HCPCS 70200LT
Hospital Charge Code	94270115
Hospital Revenue Code	320
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

DX ER ORBITS COMPLETE LT

Facility

$660.00

Service Code	HCPCS 70200LT
Hospital Charge Code	94270115
Hospital Revenue Code	320
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER ORBITS COMPLETE RT

Facility

$250.00

Service Code	HCPCS 70200RT
Hospital Charge Code	94270117
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER ORBITS COMPLETE RT

Facility

$250.00

Service Code	HCPCS 70200RT
Hospital Charge Code	94270117
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER ORTHOPANTOGRAM

Facility

$361.00

Service Code	HCPCS 70355
Hospital Charge Code	94270019
Hospital Revenue Code	320
Min. Negotiated Rate	$54.15
Max. Negotiated Rate	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$54.15

Know your out-of-pocket cost for care.

All Charges