Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BILIARY DUCT CALCULUS RMVAL

Facility

$804.30

Service Code	HCPCS 74327
Hospital Charge Code	2011310
Hospital Revenue Code	320
Min. Negotiated Rate	$104.56
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$241.29
Rate for Payer: Aetna Medicare Advantage	$241.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.10
Rate for Payer: Cigna Commercial	$402.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.64
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BILIARY DUCT CALCULUS RMVAL

Facility

$804.30

Service Code	HCPCS 74327
Hospital Charge Code	2011310
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$120.64
Rate for Payer: Qualcare PPO/HMO/WC	$120.64

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$1,378.92
Max. Negotiated Rate	$5,303.55
Rate for Payer: Aetna Commercial	$3,182.13
Rate for Payer: Aetna Medicare Advantage	$3,182.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,704.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,704.81
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	$2,704.81
Rate for Payer: Cigna Commercial	$5,303.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$1,591.07
Max. Negotiated Rate	$1,591.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$919.28
Max. Negotiated Rate	$3,535.70
Rate for Payer: Aetna Commercial	$2,121.42
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$919.28
Max. Negotiated Rate	$3,535.70
Rate for Payer: Aetna Commercial	$2,121.42
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR BIOPSY LUNG MED PERC

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2002236
Hospital Revenue Code	320
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$319.50
Rate for Payer: Aetna Medicare Advantage	$319.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.57
Rate for Payer: Cigna Commercial	$138.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR BIOPSY LUNG MED PERC

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2002236
Hospital Revenue Code	320
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$159.75
Rate for Payer: Qualcare PPO/HMO/WC	$159.75

XR BIOPSY OF THYROID

Facility

$2,031.30

Service Code	HCPCS 60100
Hospital Charge Code	5600177
Hospital Revenue Code	361
Min. Negotiated Rate	$304.69
Max. Negotiated Rate	$304.69
Rate for Payer: Qualcare PPO/HMO/WC	$304.69

XR BIOPSY OF THYROID

Facility

$2,031.30

Service Code	HCPCS 60100
Hospital Charge Code	5600177
Hospital Revenue Code	361
Min. Negotiated Rate	$264.07
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$609.39
Rate for Payer: Aetna Medicare Advantage	$609.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.98
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	$517.98
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.07
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$304.69
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	7411438
Hospital Revenue Code	361
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$90.38
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
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	$76.82
Rate for Payer: Cigna Commercial	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5600040
Hospital Revenue Code	361
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$90.38
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
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	$76.82
Rate for Payer: Cigna Commercial	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5600040
Hospital Revenue Code	361
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	7411438
Hospital Revenue Code	361
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$30.01
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	$30.01
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

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$35.01
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	$35.01
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

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$35.01
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	$35.01
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

XR BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

Know your out-of-pocket cost for care.

All Charges