Heights University Hospital

All Charges

Charge

Type

Setting

Price

ST LARYNGEAL FUNCTION STUDIES

Facility

$2,400.00

Service Code	HCPCS 92520GN
Hospital Charge Code	74204015
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

ST LARYNGEAL FUNCTION STUDIES

Facility

$2,400.00

Service Code	HCPCS 92520GN
Hospital Charge Code	74204015
Hospital Revenue Code	444
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ST LIBE MONO 4.0x28m 389342840

Facility

$4,375.00

Hospital Charge Code	270639382
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBE MONO 4.0x28m 389342840

Facility

$4,375.00

Hospital Charge Code	270639382
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBER MONO 3.0x12m389341230

Facility

$1,250.00

Hospital Charge Code	270638462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 3.0x12m389341230

Facility

$1,250.00

Hospital Charge Code	270638462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 3.0x28m389342830

Facility

$1,250.00

Hospital Charge Code	270638598
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 3.0x28m389342830

Facility

$1,250.00

Hospital Charge Code	270638598
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ST LIBER MONO 4.0x8m 38934840

Facility

$4,375.00

Hospital Charge Code	270638316
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBER MONO 4.0x8m 38934840

Facility

$4,375.00

Hospital Charge Code	270638316
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBERTE MONO 3.0x8 38934830

Facility

$4,375.00

Hospital Charge Code	270638594
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIBERTE MONO 3.0x8 38934830

Facility

$4,375.00

Hospital Charge Code	270638594
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIB MONO 2.75x32m 389343227

Facility

$4,375.00

Hospital Charge Code	270639377
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIB MONO 2.75x32m 389343227

Facility

$4,375.00

Hospital Charge Code	270639377
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIB MONO 4.5x28m 389342845

Facility

$4,375.00

Hospital Charge Code	270639385
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ST LIB MONO 4.5x28m 389342845

Facility

$4,375.00

Hospital Charge Code	270639385
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

STM HIP NCK ANGL35MM SZ4 105MM

Facility

$13,604.50

Service Code	HCPCS C1776
Hospital Charge Code	270671304
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.67
Max. Negotiated Rate	$6,802.25
Rate for Payer: Aetna Commercial	$4,081.35
Rate for Payer: Aetna Medicare Advantage	$4,081.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,469.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,469.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,469.15
Rate for Payer: Cigna Commercial	$6,802.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,292.29
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.67

STM HIP NCK ANGL35MM SZ4 105MM

Facility

$13,604.50

Service Code	HCPCS C1776
Hospital Charge Code	270671304
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.67
Max. Negotiated Rate	$3,292.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,292.29
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.67

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	74204003
Hospital Revenue Code	440
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$472.27
Rate for Payer: Aetna Medicare Advantage	$472.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.43
Rate for Payer: Cigna Commercial	$101.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.65
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$686.00

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	9109125
Hospital Revenue Code	440
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$472.27
Rate for Payer: Aetna Medicare Advantage	$472.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.43
Rate for Payer: Cigna Commercial	$101.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.65
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$686.00

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	9109125
Hospital Revenue Code	440
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	74204003
Hospital Revenue Code	440
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

STM POR 16mX160m INTEG X170316

Facility

$19,755.75

Hospital Charge Code	270636137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,963.36
Max. Negotiated Rate	$4,780.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36

Know your out-of-pocket cost for care.

All Charges