Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX ER ORTHOPANTOGRAM

Facility

$361.00

Service Code	HCPCS 70355
Hospital Charge Code	94270019
Hospital Revenue Code	320
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$108.30
Rate for Payer: Aetna Medicare Advantage	$108.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.06
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.93
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER PARANASAL SINUS 3VW

Facility

$761.00

Service Code	HCPCS 70220
Hospital Charge Code	94270011
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$228.30
Rate for Payer: Aetna Medicare Advantage	$228.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.06
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	$194.06
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.93
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX ER PARANASAL SINUS 3VW

Facility

$761.00

Service Code	HCPCS 70220
Hospital Charge Code	94270011
Hospital Revenue Code	320
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$114.15
Rate for Payer: Qualcare PPO/HMO/WC	$114.15

DX ER PELVIS

Facility

$358.00

Service Code	HCPCS 72170
Hospital Charge Code	94270049
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$107.40
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
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	$91.29
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER PELVIS

Facility

$358.00

Service Code	HCPCS 72170
Hospital Charge Code	94270049
Hospital Revenue Code	320
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

DX ER PELVIS MULTIPLE VWS

Facility

$603.00

Service Code	HCPCS 72190
Hospital Charge Code	94270051
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$180.90
Rate for Payer: Aetna Medicare Advantage	$180.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.76
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	$153.76
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.39
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER PELVIS MULTIPLE VWS

Facility

$603.00

Service Code	HCPCS 72190
Hospital Charge Code	94270051
Hospital Revenue Code	320
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

DX ER RIBS 2VIEWS LT

Facility

$569.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94270119
Hospital Revenue Code	320
Min. Negotiated Rate	$73.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$170.70
Rate for Payer: Aetna Medicare Advantage	$170.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.09
Rate for Payer: Cigna Commercial	$284.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS 2VIEWS LT

Facility

$569.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94270119
Hospital Revenue Code	320
Min. Negotiated Rate	$85.35
Max. Negotiated Rate	$85.35
Rate for Payer: Qualcare PPO/HMO/WC	$85.35

DX ER RIBS 2 VIEWS RT

Facility

$250.00

Service Code	HCPCS 71100RT
Hospital Charge Code	94270121
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 RIBS 2 VIEWS RT

Facility

$250.00

Service Code	HCPCS 71100RT
Hospital Charge Code	94270121
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 RIBS 2VWS RT

Facility

$569.00

Service Code	HCPCS 71100
Hospital Charge Code	94270029
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$170.70
Rate for Payer: Aetna Medicare Advantage	$170.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.09
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS 2VWS RT

Facility

$569.00

Service Code	HCPCS 71100
Hospital Charge Code	94270029
Hospital Revenue Code	320
Min. Negotiated Rate	$85.35
Max. Negotiated Rate	$85.35
Rate for Payer: Qualcare PPO/HMO/WC	$85.35

DX ER RIBS BILAT

Facility

$625.00

Service Code	HCPCS 71110
Hospital Charge Code	94270031
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
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	$159.38
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS BILAT

Facility

$625.00

Service Code	HCPCS 71110
Hospital Charge Code	94270031
Hospital Revenue Code	320
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

DX ER RIBS & CHEST LT

Facility

$523.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270125
Hospital Revenue Code	320
Min. Negotiated Rate	$67.99
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$156.90
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS & CHEST LT

Facility

$523.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270125
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

DX ER RIBS + CHEST LT

Facility

$250.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270123
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 RIBS + CHEST LT

Facility

$250.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270123
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 RIBS + CHEST RT

Facility

$523.00

Service Code	HCPCS 71101RT
Hospital Charge Code	94270127
Hospital Revenue Code	320
Min. Negotiated Rate	$67.99
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$156.90
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS + CHEST RT

Facility

$523.00

Service Code	HCPCS 71101RT
Hospital Charge Code	94270127
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

DX ER RIBS W/CHEST BILAT

Facility

$697.00

Service Code	HCPCS 71111
Hospital Charge Code	94270033
Hospital Revenue Code	320
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$209.10
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER RIBS W/CHEST BILAT

Facility

$697.00

Service Code	HCPCS 71111
Hospital Charge Code	94270033
Hospital Revenue Code	320
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

DX ER SACRUM&COCCYX 2 VWS

Facility

$250.00

Service Code	HCPCS 72220
Hospital Charge Code	94270053
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 SACRUM&COCCYX 2 VWS

Facility

$250.00

Service Code	HCPCS 72220
Hospital Charge Code	94270053
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
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) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$207.24
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19

Know your out-of-pocket cost for care.

All Charges