Heights University Hospital

All Charges

Charge

Type

Setting

Price

SMA AND CELIAC DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053205
Hospital Revenue Code	921
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

SMA AND CELIAC DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	74115049
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

SMA AND CELIAC DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	2692080
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

SMA AND CELIAC DUPLEX

Facility

$789.00

Service Code	HCPCS 93975
Hospital Charge Code	74116049
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA AND CELIAC DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	74115049
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

SMA AND CELIAC DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053205
Hospital Revenue Code	921
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$504.00
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
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	$428.40
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.40
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

SMA AND CELIAC DUPLEX

Facility

$789.00

Service Code	HCPCS 93975
Hospital Charge Code	74117049
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

$789.00

Service Code	HCPCS 93975
Hospital Charge Code	74117049
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA AND CELIAC DUPLEX LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74115052
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	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
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 LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74116052
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA AND CELIAC DUPLEX LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74115052
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA AND CELIAC DUPLEX LTD

Facility

$1,555.25

Service Code	HCPCS 93976
Hospital Charge Code	94053270
Hospital Revenue Code	921
Min. Negotiated Rate	$233.29
Max. Negotiated Rate	$233.29
Rate for Payer: Qualcare PPO/HMO/WC	$233.29

SMA AND CELIAC DUPLEX LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74117052
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	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
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 LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74117052
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA AND CELIAC DUPLEX LTD

Facility

$789.00

Service Code	HCPCS 93976
Hospital Charge Code	74116052
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	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$248.96
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 LTD

Facility

$1,555.25

Service Code	HCPCS 93976
Hospital Charge Code	94053270
Hospital Revenue Code	921
Min. Negotiated Rate	$202.18
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$466.57
Rate for Payer: Aetna Medicare Advantage	$466.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$396.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$396.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$396.59
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.18
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$233.29
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

SMA CARRIER TEST

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900027
Hospital Revenue Code	310
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$501.97
Rate for Payer: Aetna Commercial	$443.88
Rate for Payer: Aetna Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.97
Rate for Payer: Cigna Commercial	$137.00
Rate for Payer: Cigna Medicare Advantage	$68.50
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$145.22
Rate for Payer: Wellcare Medicare Advantage	$137.00

SMA CARRIER TEST

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900027
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

SMA & CELIAC LIMTD DUPLEX

Facility

$789.00

Hospital Charge Code	2692085
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) PPO	$201.19
Rate for Payer: Cigna Commercial	$394.50
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 & CELIAC LIMTD DUPLEX

Facility

$789.00

Hospital Charge Code	2692085
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

SMA & CELIAC LIMTD DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053210
Hospital Revenue Code	921
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$5,061.00
Rate for Payer: Aetna Commercial	$504.00
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
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	$428.40
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.40
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

SMA & CELIAC LIMTD DUPLEX

Facility

$1,680.00

Service Code	HCPCS 93975
Hospital Charge Code	94053210
Hospital Revenue Code	921
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

SMALL 11MM 8 DEG PLATE

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704097
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

SMALL 11MM 8 DEG PLATE

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704097
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

SMALL BONE FIXATION SYSTEM

Facility

$7,145.00

Hospital Charge Code	270661291
Hospital Revenue Code	278
Min. Negotiated Rate	$1,071.75
Max. Negotiated Rate	$1,729.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.75

Know your out-of-pocket cost for care.

All Charges