Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX ER SCAPULA COMP BIL

Facility

$250.00

Service Code	HCPCS 7301050
Hospital Charge Code	94270075
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 SCAPULA COMP BIL

Facility

$250.00

Service Code	HCPCS 7301050
Hospital Charge Code	94270075
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 SCAPULA COMPLETE LT

Facility

$250.00

Service Code	HCPCS 73010LT
Hospital Charge Code	94270133
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 SCAPULA COMPLETE LT

Facility

$250.00

Service Code	HCPCS 73010LT
Hospital Charge Code	94270133
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 SCAPULA COMPLETE RT

Facility

$294.00

Service Code	HCPCS 73010RT
Hospital Charge Code	94270137
Hospital Revenue Code	320
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

DX ER SCAPULA COMPLETE RT

Facility

$294.00

Service Code	HCPCS 73010RT
Hospital Charge Code	94270137
Hospital Revenue Code	320
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER SCAPULA COMP LT

Facility

$294.00

Service Code	HCPCS 73010LT
Hospital Charge Code	94270135
Hospital Revenue Code	320
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

DX ER SCAPULA COMP LT

Facility

$294.00

Service Code	HCPCS 73010LT
Hospital Charge Code	94270135
Hospital Revenue Code	320
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER SHOULDER 2VWS BIL

Facility

$250.00

Service Code	HCPCS 7303050
Hospital Charge Code	94270077
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 SHOULDER 2VWS BIL

Facility

$250.00

Service Code	HCPCS 7303050
Hospital Charge Code	94270077
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 SHOULDER MIN 2 LT

Facility

$332.00

Service Code	HCPCS 73030LT
Hospital Charge Code	94270139
Hospital Revenue Code	320
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER SHOULDER MIN 2 LT

Facility

$332.00

Service Code	HCPCS 73030LT
Hospital Charge Code	94270139
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

DX ER SHOULDER MIN 2 RT

Facility

$332.00

Service Code	HCPCS 73030RT
Hospital Charge Code	94270141
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

DX ER SHOULDER MIN 2 RT

Facility

$332.00

Service Code	HCPCS 73030RT
Hospital Charge Code	94270141
Hospital Revenue Code	320
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX ER SINUSES <3VIEWS

Facility

$473.00

Service Code	HCPCS 70210
Hospital Charge Code	94270009
Hospital Revenue Code	320
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$70.95
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

DX ER SINUSES <3VIEWS

Facility

$473.00

Service Code	HCPCS 70210
Hospital Charge Code	94270009
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$141.90
Rate for Payer: Aetna Medicare Advantage	$141.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.61
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	$120.61
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.49
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX ER SKULL COMPL 4 VWS

Facility

$638.00

Service Code	HCPCS 70260
Hospital Charge Code	94270015
Hospital Revenue Code	320
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

DX ER SKULL COMPL 4 VWS

Facility

$638.00

Service Code	HCPCS 70260
Hospital Charge Code	94270015
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	$191.40
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER SKULL LESS THAN 4VW

Facility

$344.00

Service Code	HCPCS 70250
Hospital Charge Code	94270013
Hospital Revenue Code	320
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$51.60

DX ER SKULL LESS THAN 4VW

Facility

$344.00

Service Code	HCPCS 70250
Hospital Charge Code	94270013
Hospital Revenue Code	320
Min. Negotiated Rate	$35.21
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$103.20
Rate for Payer: Aetna Medicare Advantage	$103.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.72
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

DX ER STERNUM 2 VWS

Facility

$250.00

Service Code	HCPCS 71120
Hospital Charge Code	94270035
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 STERNUM 2 VWS

Facility

$250.00

Service Code	HCPCS 71120
Hospital Charge Code	94270035
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) NJ Health	$33.85
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

DX ER THORACIC SPINE

Facility

$569.00

Service Code	HCPCS 72070
Hospital Charge Code	94270043
Hospital Revenue Code	320
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.09
Rate for Payer: Cigna Commercial	$248.96
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX ER THORACIC SPINE

Facility

$569.00

Service Code	HCPCS 72070
Hospital Charge Code	94270043
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 TMJ'S OPEN&CLSD BIL

Facility

$759.00

Service Code	HCPCS 70330
Hospital Charge Code	94270017
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$227.70
Rate for Payer: Aetna Medicare Advantage	$227.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.54
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	$193.54
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

Know your out-of-pocket cost for care.

All Charges