Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX-RETROGRAD UROGRAPH-BI

Facility

$5,100.00

Service Code	HCPCS 7442050
Hospital Charge Code	2009155
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-RETROGRAD UROGRAPH-BI

Facility

$5,100.00

Service Code	HCPCS 7442050
Hospital Charge Code	2009155
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RETROGRAD UROGRAPH-LT

Facility

$1,012.00

Service Code	HCPCS 74420LT
Hospital Charge Code	2009250
Hospital Revenue Code	320
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$151.80

DX-RETROGRAD UROGRAPH-LT

Facility

$1,012.00

Service Code	HCPCS 74420LT
Hospital Charge Code	2009250
Hospital Revenue Code	320
Min. Negotiated Rate	$131.56
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$303.60
Rate for Payer: Aetna Medicare Advantage	$303.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.06
Rate for Payer: Cigna Commercial	$506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$151.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-RETROGRAD UROGRAPH-RT

Facility

$1,012.00

Service Code	HCPCS 74420
Hospital Charge Code	2009255
Hospital Revenue Code	320
Min. Negotiated Rate	$91.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$303.60
Rate for Payer: Aetna Medicare Advantage	$303.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.06
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$151.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-RETROGRAD UROGRAPH-RT

Facility

$1,012.00

Service Code	HCPCS 74420
Hospital Charge Code	2009255
Hospital Revenue Code	320
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$151.80

DX-RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009365
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009365
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,530.00
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) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
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-RIBS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009360
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RIBS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009360
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,530.00
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) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
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-RIBS W/CHEST 3 VIEWS-LT

Facility

$448.00

Service Code	HCPCS 71101LT
Hospital Charge Code	2007010
Hospital Revenue Code	320
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

DX-RIBS W/CHEST 3 VIEWS-LT

Facility

$448.00

Service Code	HCPCS 71101LT
Hospital Charge Code	2007010
Hospital Revenue Code	320
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$134.40
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-RIBS W/CHEST 3 VIEWS-RT

Facility

$448.00

Service Code	HCPCS 71101RT
Hospital Charge Code	2007005
Hospital Revenue Code	320
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$134.40
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-RIBS W/CHEST 3 VIEWS-RT

Facility

$448.00

Service Code	HCPCS 71101RT
Hospital Charge Code	2007005
Hospital Revenue Code	320
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

DX SHOULDER 1 VW

Facility

$267.00

Service Code	HCPCS 73020
Hospital Charge Code	2011515
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
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	$68.08
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.71
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

DX SHOULDER 1 VW

Facility

$267.00

Service Code	HCPCS 73020
Hospital Charge Code	2011515
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX-SHUNTOGRAM

Facility

$318.00

Hospital Charge Code	2009090
Hospital Revenue Code	320
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$95.40
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-SHUNTOGRAM

Facility

$318.00

Hospital Charge Code	2009090
Hospital Revenue Code	320
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

DX-SPINAL SELECTIVE-BI

Facility

$8,633.00

Service Code	HCPCS 7570550
Hospital Charge Code	7411839
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-BI

Facility

$8,633.00

Service Code	HCPCS 7570550
Hospital Charge Code	2690745
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-SPINAL SELECTIVE-BI

Facility

$8,633.00

Service Code	HCPCS 7570550
Hospital Charge Code	2690745
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-BI

Facility

$8,633.00

Service Code	HCPCS 7570550
Hospital Charge Code	7411839
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	7412000
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	2691855
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	7412000
Hospital Revenue Code	320
Min. Negotiated Rate	$1,122.29
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$2,589.90
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges