Heights University Hospital

All Charges

Charge

Type

Setting

Price

XRAY FOR BONE AGE-TC

Facility

$84.55

Service Code	HCPCS 77072TC
Hospital Charge Code	85000210
Hospital Revenue Code	320
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$25.36
Rate for Payer: Aetna Medicare Advantage	$25.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.56
Rate for Payer: Cigna Commercial	$42.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.68
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY JACKET MASTER COLOR RED

Facility

$499.30

Hospital Charge Code	270658995
Hospital Revenue Code	270
Min. Negotiated Rate	$64.91
Max. Negotiated Rate	$249.65
Rate for Payer: Aetna Commercial	$149.79
Rate for Payer: Aetna Medicare Advantage	$149.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.32
Rate for Payer: Cigna Commercial	$249.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.91
Rate for Payer: Oxford Commercial	$249.65
Rate for Payer: Qualcare PPO/HMO/WC	$74.89
Rate for Payer: UnitedHealthcare Commercial	$249.65

XRAY JACKET MASTER COLOR RED

Facility

$499.30

Hospital Charge Code	270658995
Hospital Revenue Code	270
Min. Negotiated Rate	$74.89
Max. Negotiated Rate	$74.89
Rate for Payer: Qualcare PPO/HMO/WC	$74.89

XRAY OF MAMM DUCT-GL

Facility

$1,656.79

Service Code	HCPCS 77053
Hospital Charge Code	85000095
Hospital Revenue Code	320
Min. Negotiated Rate	$248.52
Max. Negotiated Rate	$248.52
Rate for Payer: Qualcare PPO/HMO/WC	$248.52

XRAY OF MAMM DUCT-GL

Facility

$1,656.79

Service Code	HCPCS 77053
Hospital Charge Code	85000095
Hospital Revenue Code	320
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$497.04
Rate for Payer: Aetna Medicare Advantage	$497.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.48
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.38
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.52
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY OF MAMM DUCT-PC

Facility

$92.00

Service Code	HCPCS 7705326
Hospital Charge Code	85000105
Hospital Revenue Code	320
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$27.60
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY OF MAMM DUCT-PC

Facility

$92.00

Service Code	HCPCS 7705326
Hospital Charge Code	85000105
Hospital Revenue Code	320
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

XRAY OF MAMM DUCTS-GL

Facility

$1,656.79

Service Code	HCPCS 77054
Hospital Charge Code	85000110
Hospital Revenue Code	320
Min. Negotiated Rate	$115.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$497.04
Rate for Payer: Aetna Medicare Advantage	$497.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.48
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.38
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.52
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY OF MAMM DUCTS-GL

Facility

$1,656.79

Service Code	HCPCS 77054
Hospital Charge Code	85000110
Hospital Revenue Code	320
Min. Negotiated Rate	$248.52
Max. Negotiated Rate	$248.52
Rate for Payer: Qualcare PPO/HMO/WC	$248.52

XRAY OF MAMM DUCTS-PC

Facility

$119.60

Service Code	HCPCS 7705426
Hospital Charge Code	85000120
Hospital Revenue Code	320
Min. Negotiated Rate	$15.55
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$35.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.50
Rate for Payer: Cigna Commercial	$59.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY OF MAMM DUCTS-PC

Facility

$119.60

Service Code	HCPCS 7705426
Hospital Charge Code	85000120
Hospital Revenue Code	320
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$17.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.94

XRAY OF MAMM DUCTS-TC

Facility

$383.25

Service Code	HCPCS 77054TC
Hospital Charge Code	85000115
Hospital Revenue Code	320
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

XRAY OF MAMM DUCTS-TC

Facility

$383.25

Service Code	HCPCS 77054TC
Hospital Charge Code	85000115
Hospital Revenue Code	320
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$114.97
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.82
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY OF MAMM DUCT-TC

Facility

$276.30

Service Code	HCPCS 77053TC
Hospital Charge Code	85000100
Hospital Revenue Code	320
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$41.45
Rate for Payer: Qualcare PPO/HMO/WC	$41.45

XRAY OF MAMM DUCT-TC

Facility

$276.30

Service Code	HCPCS 77053TC
Hospital Charge Code	85000100
Hospital Revenue Code	320
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$82.89
Rate for Payer: Aetna Medicare Advantage	$82.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.46
Rate for Payer: Cigna Commercial	$138.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.92
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE LENGTH STUDIES-GL

Facility

$459.43

Service Code	HCPCS 77073
Hospital Charge Code	85000220
Hospital Revenue Code	320
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna Medicare Advantage	$137.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.15
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.73
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.91
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XRAYS BONE LENGTH STUDIES-GL

Facility

$459.43

Service Code	HCPCS 77073
Hospital Charge Code	85000220
Hospital Revenue Code	320
Min. Negotiated Rate	$68.91
Max. Negotiated Rate	$68.91
Rate for Payer: Qualcare PPO/HMO/WC	$68.91

XRAYS BONE LENGTH STUDIES-PC

Facility

$79.30

Service Code	HCPCS 7707326
Hospital Charge Code	85000230
Hospital Revenue Code	320
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$23.79
Rate for Payer: Aetna Medicare Advantage	$23.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.22
Rate for Payer: Cigna Commercial	$39.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.89
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE LENGTH STUDIES-PC

Facility

$79.30

Service Code	HCPCS 7707326
Hospital Charge Code	85000230
Hospital Revenue Code	320
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$11.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.89

XRAYS BONE LENGTH STUDIES-TC

Facility

$147.10

Service Code	HCPCS 77073TC
Hospital Charge Code	85000225
Hospital Revenue Code	320
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$22.07
Rate for Payer: Qualcare PPO/HMO/WC	$22.07

XRAYS BONE LENGTH STUDIES-TC

Facility

$147.10

Service Code	HCPCS 77073TC
Hospital Charge Code	85000225
Hospital Revenue Code	320
Min. Negotiated Rate	$19.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$44.13
Rate for Payer: Aetna Medicare Advantage	$44.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.51
Rate for Payer: Cigna Commercial	$73.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.07
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY CMPL-GL

Facility

$459.43

Service Code	HCPCS 77075
Hospital Charge Code	85000250
Hospital Revenue Code	320
Min. Negotiated Rate	$68.91
Max. Negotiated Rate	$68.91
Rate for Payer: Qualcare PPO/HMO/WC	$68.91

XRAYS BONE SURVEY CMPL-GL

Facility

$459.43

Service Code	HCPCS 77075
Hospital Charge Code	85000250
Hospital Revenue Code	320
Min. Negotiated Rate	$52.38
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna Medicare Advantage	$137.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.15
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.73
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.91
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XRAYS BONE SURVEY CMPL-PC

Facility

$143.65

Service Code	HCPCS 7707526
Hospital Charge Code	85000260
Hospital Revenue Code	320
Min. Negotiated Rate	$18.67
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$43.09
Rate for Payer: Aetna Medicare Advantage	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.63
Rate for Payer: Cigna Commercial	$71.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.67
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.55
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY CMPL-PC

Facility

$143.65

Service Code	HCPCS 7707526
Hospital Charge Code	85000260
Hospital Revenue Code	320
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.55

Know your out-of-pocket cost for care.

All Charges