Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	321074425L
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	7411992
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	2691760
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	321074425R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	366874425R
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	2691765
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	366874425R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	321074425R
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	2691765
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	7411993
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	7411993
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2009150
Hospital Revenue Code	320
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

DX-ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2009150
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	2009210
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	2009210
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-ORBITS COMP MIN 4VW-RT

Facility

$5,100.00

Service Code	HCPCS 70200RT
Hospital Charge Code	2009215
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-RT

Facility

$5,100.00

Service Code	HCPCS 70200RT
Hospital Charge Code	2009215
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-ORTHOPANTOGRAM

Facility

$492.00

Hospital Charge Code	2009025
Hospital Revenue Code	320
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

DX-ORTHOPANTOGRAM

Facility

$492.00

Hospital Charge Code	2009025
Hospital Revenue Code	320
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$1,489.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Aetna Commercial	$147.60
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.96
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-PERC DRAINAGE OR STENT

Facility

$919.00

Hospital Charge Code	2009315
Hospital Revenue Code	320
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$137.85
Rate for Payer: Qualcare PPO/HMO/WC	$137.85

DX-PERC DRAINAGE OR STENT

Facility

$919.00

Hospital Charge Code	2009315
Hospital Revenue Code	320
Min. Negotiated Rate	$119.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$275.70
Rate for Payer: Aetna Medicare Advantage	$275.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.34
Rate for Payer: Cigna Commercial	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-PERC DRAIN OR STENT-BI

Facility

$919.00

Hospital Charge Code	2009160
Hospital Revenue Code	320
Min. Negotiated Rate	$119.47
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$275.70
Rate for Payer: Aetna Medicare Advantage	$275.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.34
Rate for Payer: Cigna Commercial	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-PERC DRAIN OR STENT-BI

Facility

$919.00

Hospital Charge Code	2009160
Hospital Revenue Code	320
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$137.85
Rate for Payer: Qualcare PPO/HMO/WC	$137.85

Know your out-of-pocket cost for care.

All Charges