Heights University Hospital

All Charges

Charge

Type

Setting

Price

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	2691855
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-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	7412001
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-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	2691860
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-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	7412001
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-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	2691860
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-STERNOCLAVICULAR JT-BI

Facility

$250.00

Hospital Charge Code	2009340
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-STERNOCLAVICULAR JT-BI

Facility

$250.00

Hospital Charge Code	2009340
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-STERNOCLAVICULAR JT-LT

Facility

$468.00

Hospital Charge Code	2009335
Hospital Revenue Code	320
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$140.40
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.84
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-STERNOCLAVICULAR JT-LT

Facility

$468.00

Hospital Charge Code	2009335
Hospital Revenue Code	320
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

DX-STERNOCLAVICULAR JT-RT

Facility

$250.00

Hospital Charge Code	2009230
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-STERNOCLAVICULAR JT-RT

Facility

$250.00

Hospital Charge Code	2009230
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-STRTC GD FR BRST BX-BI

Facility

$802.00

Hospital Charge Code	2009175
Hospital Revenue Code	320
Min. Negotiated Rate	$104.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$240.60
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-STRTC GD FR BRST BX-BI

Facility

$802.00

Hospital Charge Code	2009175
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-STRTC GD FR BRST BX-LT

Facility

$802.00

Hospital Charge Code	2009285
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-STRTC GD FR BRST BX-LT

Facility

$802.00

Hospital Charge Code	2009285
Hospital Revenue Code	320
Min. Negotiated Rate	$104.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$240.60
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-STRTC GD FR BRST BX-RT

Facility

$802.00

Hospital Charge Code	2009290
Hospital Revenue Code	320
Min. Negotiated Rate	$104.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$240.60
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-STRTC GD FR BRST BX-RT

Facility

$802.00

Hospital Charge Code	2009290
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$75.79
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	$75.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$417.70
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-TC INTRO OF IV STENT

Facility

$6,122.00

Hospital Charge Code	2009110
Hospital Revenue Code	320
Min. Negotiated Rate	$795.86
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$1,836.60
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-TC INTRO OF IV STENT

Facility

$6,122.00

Hospital Charge Code	2009110
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$123.60
Rate for Payer: Aetna Medicare Advantage	$123.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.06
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$61.80
Max. Negotiated Rate	$61.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.80

DX-TOE 2ND DIGIT LT

Facility

$267.00

Service Code	HCPCS 7366050
Hospital Charge Code	2007055
Hospital Revenue Code	320
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$1,489.00
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) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
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

DX-TOE 2ND DIGIT LT

Facility

$267.00

Service Code	HCPCS 7366050
Hospital Charge Code	2007055
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

Know your out-of-pocket cost for care.

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