Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPINAL SYSTEM DTRAX

Facility

$14,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692492
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

SPINE ACCESS KIT, DISPOSABLE

Facility

$375.00

Hospital Charge Code	270702072
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SPINE ACCESS KIT, DISPOSABLE

Facility

$375.00

Hospital Charge Code	270702072
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SPINECATH INTADISCAL CATHETER

Facility

$10,500.00

Hospital Charge Code	270657285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,150.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SPINECATH INTADISCAL CATHETER

Facility

$10,500.00

Hospital Charge Code	270657285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SPINE ENTIRE 1 VIEW

Facility

$5,100.00

Service Code	HCPCS 72081
Hospital Charge Code	2011556
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE ENTIRE 1 VIEW

Facility

$5,100.00

Service Code	HCPCS 72081
Hospital Charge Code	94061477
Hospital Revenue Code	320
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$40.15
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

SPINE ENTIRE 1 VIEW

Facility

$5,100.00

Service Code	HCPCS 72081
Hospital Charge Code	94061477
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE ENTIRE 1 VIEW

Facility

$5,100.00

Service Code	HCPCS 72081
Hospital Charge Code	2011556
Hospital Revenue Code	320
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$40.15
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

SPINE ENTIRE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2011557
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE ENTIRE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2011557
Hospital Revenue Code	320
Min. Negotiated Rate	$64.83
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	$64.83
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

SPINE ENTIRE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	94061476
Hospital Revenue Code	320
Min. Negotiated Rate	$64.83
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	$64.83
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

SPINE ENTIRE 2-3 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	94061476
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE ENTIRE 4-5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 72083
Hospital Charge Code	94061478
Hospital Revenue Code	320
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,837.41
Rate for Payer: Aetna Better Health Medicaid	$1,801.38
Rate for Payer: Aetna Commercial	$339.32
Rate for Payer: Aetna Medicare Advantage	$339.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.42
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.66
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,837.41

SPINE ENTIRE 4-5 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72083
Hospital Charge Code	2011558
Hospital Revenue Code	320
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,837.41
Rate for Payer: Aetna Better Health Medicaid	$1,801.38
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	$70.35
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	$1,837.41

SPINE ENTIRE 4-5 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72083
Hospital Charge Code	2011558
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE ENTIRE 4-5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 72083
Hospital Charge Code	94061478
Hospital Revenue Code	320
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$169.66
Rate for Payer: Qualcare PPO/HMO/WC	$169.66

SPINE ENTIRE MIN 6 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72084
Hospital Charge Code	2011559
Hospital Revenue Code	320
Min. Negotiated Rate	$84.09
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$801.35
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	$84.09
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	$817.38

SPINE ENTIRE MIN 6 VIEWS

Facility

$1,131.07

Service Code	HCPCS 72084
Hospital Charge Code	94061479
Hospital Revenue Code	320
Min. Negotiated Rate	$84.09
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$801.35
Rate for Payer: Aetna Commercial	$339.32
Rate for Payer: Aetna Medicare Advantage	$339.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.42
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.66
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$817.38

SPINE ENTIRE MIN 6 VIEWS

Facility

$1,131.07

Service Code	HCPCS 72084
Hospital Charge Code	94061479
Hospital Revenue Code	320
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$169.66
Rate for Payer: Qualcare PPO/HMO/WC	$169.66

SPINE ENTIRE MIN 6 VIEWS

Facility

$5,100.00

Service Code	HCPCS 72084
Hospital Charge Code	2011559
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SPINE FUSE&REMV CERV BEL C2,SG

Facility

$44,286.00

Service Code	HCPCS 22551
Hospital Charge Code	16000384
Hospital Revenue Code	360
Min. Negotiated Rate	$6,642.90
Max. Negotiated Rate	$6,642.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90

SPINE FUSE&REMV CERV BEL C2,SG

Facility

$44,286.00

Service Code	HCPCS 22551
Hospital Charge Code	16000384
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$13,285.80
Rate for Payer: Aetna Medicare Advantage	$13,285.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,292.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,292.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,292.93
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,757.18
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

SPINE FUSE&REMV CERV BEL C2,SG

Facility

$44,286.00

Service Code	HCPCS 22551
Hospital Charge Code	1620001
Hospital Revenue Code	360
Min. Negotiated Rate	$6,642.90
Max. Negotiated Rate	$6,642.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90

SPINE FUSE&REMV CERV BEL C2,SG

Facility

$44,286.00

Service Code	HCPCS 22551
Hospital Charge Code	1620001
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$13,285.80
Rate for Payer: Aetna Medicare Advantage	$13,285.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,292.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,292.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,292.93
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,757.18
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

Know your out-of-pocket cost for care.

All Charges