Heights University Hospital

All Charges

Charge

Type

Setting

Price

XRAYS BONE SURVEY CMPL-TC

Facility

$447.85

Service Code	HCPCS 77075TC
Hospital Charge Code	85000255
Hospital Revenue Code	320
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$134.35
Rate for Payer: Aetna Medicare Advantage	$134.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.20
Rate for Payer: Cigna Commercial	$223.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY CMPL-TC

Facility

$447.85

Service Code	HCPCS 77075TC
Hospital Charge Code	85000255
Hospital Revenue Code	320
Min. Negotiated Rate	$67.18
Max. Negotiated Rate	$67.18
Rate for Payer: Qualcare PPO/HMO/WC	$67.18

XRAYS BONE SURVEY INFANT-GL

Facility

$459.43

Service Code	HCPCS 77076
Hospital Charge Code	85000265
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 INFANT-GL

Facility

$459.43

Service Code	HCPCS 77076
Hospital Charge Code	85000265
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
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	$32.50
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 INFANT-PC

Facility

$186.00

Service Code	HCPCS 7707626
Hospital Charge Code	85000275
Hospital Revenue Code	320
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

XRAYS BONE SURVEY INFANT-PC

Facility

$186.00

Service Code	HCPCS 7707626
Hospital Charge Code	85000275
Hospital Revenue Code	320
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.18
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY INFANT-TC

Facility

$445.85

Service Code	HCPCS 77076TC
Hospital Charge Code	85000270
Hospital Revenue Code	320
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$133.75
Rate for Payer: Aetna Medicare Advantage	$133.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.69
Rate for Payer: Cigna Commercial	$222.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.96
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.88
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY INFANT-TC

Facility

$445.85

Service Code	HCPCS 77076TC
Hospital Charge Code	85000270
Hospital Revenue Code	320
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$66.88
Rate for Payer: Qualcare PPO/HMO/WC	$66.88

XRAYS BONE SURVEY LTD-GL

Facility

$459.43

Service Code	HCPCS 77074
Hospital Charge Code	85000235
Hospital Revenue Code	320
Min. Negotiated Rate	$35.01
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	$35.01
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 LTD-GL

Facility

$459.43

Service Code	HCPCS 77074
Hospital Charge Code	85000235
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 LTD-PC

Facility

$119.60

Service Code	HCPCS 7707426
Hospital Charge Code	85000245
Hospital Revenue Code	320
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$17.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.94

XRAYS BONE SURVEY LTD-PC

Facility

$119.60

Service Code	HCPCS 7707426
Hospital Charge Code	85000245
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

XRAYS BONE SURVEY LTD-TC

Facility

$288.40

Service Code	HCPCS 77074TC
Hospital Charge Code	85000240
Hospital Revenue Code	320
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$86.52
Rate for Payer: Aetna Medicare Advantage	$86.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.54
Rate for Payer: Cigna Commercial	$144.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.49
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.26
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAYS BONE SURVEY LTD-TC

Facility

$288.40

Service Code	HCPCS 77074TC
Hospital Charge Code	85000240
Hospital Revenue Code	320
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$43.26
Rate for Payer: Qualcare PPO/HMO/WC	$43.26

XRAY STRESS VIEW

Facility

$298.01

Service Code	HCPCS 77071
Hospital Charge Code	85000200
Hospital Revenue Code	320
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$44.70
Rate for Payer: Qualcare PPO/HMO/WC	$44.70

XRAY STRESS VIEW

Facility

$298.01

Service Code	HCPCS 77071
Hospital Charge Code	85000200
Hospital Revenue Code	320
Min. Negotiated Rate	$23.06
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$89.40
Rate for Payer: Aetna Medicare Advantage	$89.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.99
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.70
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XRAY UPER GI TRACT

Facility

$510.00

Service Code	HCPCS 74241
Hospital Charge Code	94061139
Hospital Revenue Code	320
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

XRAY UPER GI TRACT

Facility

$510.00

Service Code	HCPCS 74241
Hospital Charge Code	94061139
Hospital Revenue Code	320
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XRAY UPPER GI W CONTRAST

Facility

$5,100.00

Service Code	HCPCS 74240
Hospital Charge Code	404174240
Hospital Revenue Code	320
Min. Negotiated Rate	$89.54
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	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$417.70
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

XRAY UPPER GI W CONTRAST

Facility

$5,100.00

Service Code	HCPCS 74240
Hospital Charge Code	404174240
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BARIUM ENEMA SINGLE CONT

Facility

$5,100.00

Service Code	HCPCS 74270
Hospital Charge Code	2000263
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BARIUM ENEMA SINGLE CONT

Facility

$5,100.00

Service Code	HCPCS 74270
Hospital Charge Code	2000263
Hospital Revenue Code	320
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$1,530.00
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	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$417.70
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

XR BARIUM ENEMA THERAPEUTIC

Facility

$521.00

Service Code	HCPCS 74283
Hospital Charge Code	2011309
Hospital Revenue Code	320
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$156.30
Rate for Payer: Aetna Medicare Advantage	$156.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.85
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.73
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BARIUM ENEMA THERAPEUTIC

Facility

$521.00

Service Code	HCPCS 74283
Hospital Charge Code	2011309
Hospital Revenue Code	320
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$78.15
Rate for Payer: Qualcare PPO/HMO/WC	$78.15

XR BARIUM ENEMA W/AIR CONT

Facility

$5,100.00

Service Code	HCPCS 74280
Hospital Charge Code	2001667
Hospital Revenue Code	320
Min. Negotiated Rate	$104.72
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	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$417.70
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

Know your out-of-pocket cost for care.

All Charges