Heights University Hospital

All Charges

Charge

Type

Setting

Price

SLP Expression D/C Status CL

Facility

$0.01

Service Code	HCPCS G9164GNCL
Hospital Charge Code	74204069CL
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression D/C Status CM

Facility

$0.01

Service Code	HCPCS G9164GNCM
Hospital Charge Code	74204069CM
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression D/C Status CM

Facility

$0.01

Service Code	HCPCS G9164GNCM
Hospital Charge Code	74204069CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP EXPRESSION D/C STATUS CN

Facility

$0.01

Service Code	HCPCS G9164GNCN
Hospital Charge Code	74204069CN
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP EXPRESSION D/C STATUS CN

Facility

$0.01

Service Code	HCPCS G9164GNCN
Hospital Charge Code	74204069CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CH

Facility

$0.01

Service Code	HCPCS G9163GNCH
Hospital Charge Code	74204067CH
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression Goal Status CH

Facility

$0.01

Service Code	HCPCS G9163GNCH
Hospital Charge Code	74204067CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CI

Facility

$0.01

Service Code	HCPCS G9163GNCI
Hospital Charge Code	74204067CI
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression Goal Status CI

Facility

$0.01

Service Code	HCPCS G9163GNCI
Hospital Charge Code	74204067CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9163GNCJ
Hospital Charge Code	74204067CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9163GNCJ
Hospital Charge Code	74204067CJ
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression Goal Status CK

Facility

$0.01

Service Code	HCPCS G9163GNCK
Hospital Charge Code	74204067CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CK

Facility

$0.01

Service Code	HCPCS G9163GNCK
Hospital Charge Code	74204067CK
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression Goal Status CL

Facility

$0.01

Service Code	HCPCS G9163GNCL
Hospital Charge Code	74204067CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CL

Facility

$0.01

Service Code	HCPCS G9163GNCL
Hospital Charge Code	74204067CL
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP Expression Goal Status CM

Facility

$0.01

Service Code	HCPCS G9163GNCM
Hospital Charge Code	74204067CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP Expression Goal Status CM

Facility

$0.01

Service Code	HCPCS G9163GNCM
Hospital Charge Code	74204067CM
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SLP EXPRESSION GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9163GNCN
Hospital Charge Code	74204067CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SLP EXPRESSION GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9163GNCN
Hospital Charge Code	74204067CN
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

SL-SCREW

Facility

$660.00

Hospital Charge Code	270656340
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

SL-SCREW

Facility

$660.00

Hospital Charge Code	270656340
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

SLS PLATE

Facility

$1,600.00

Hospital Charge Code	270656338
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

SLS PLATE

Facility

$1,600.00

Hospital Charge Code	270656338
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$480.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

SMA AND CELIAC DUPLEX

Facility

$789.00

Service Code	HCPCS 93975
Hospital Charge Code	74116049
Hospital Revenue Code	921
Min. Negotiated Rate	$102.57
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$236.70
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.57
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

SMA AND CELIAC DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	2692080
Hospital Revenue Code	921
Min. Negotiated Rate	$372.60
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

Know your out-of-pocket cost for care.

All Charges