Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR BRONCHOSCOPY INJ FOR XRAY

Facility

$2,480.00

Hospital Charge Code	2011230
Hospital Revenue Code	361
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR BRST PREOP PLMNT EA ADD WIR

Facility

$414.45

Service Code	HCPCS 19282
Hospital Charge Code	2004620
Hospital Revenue Code	361
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$44.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR BRST PREOP PLMNT EA ADD WIR

Facility

$414.45

Service Code	HCPCS 19282
Hospital Charge Code	2004620
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR CANNULA DECLOTTING

Facility

$6,733.80

Service Code	HCPCS 36861
Hospital Charge Code	2011265
Hospital Revenue Code	361
Min. Negotiated Rate	$1,010.07
Max. Negotiated Rate	$1,010.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,010.07

XR CANNULA DECLOTTING

Facility

$6,733.80

Service Code	HCPCS 36861
Hospital Charge Code	2011265
Hospital Revenue Code	361
Min. Negotiated Rate	$875.39
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$2,020.14
Rate for Payer: Aetna Medicare Advantage	$2,020.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,717.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,717.12
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	$1,717.12
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.39
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,010.07
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR CARDIAC SERIES MIN 4 VWS

Facility

$354.45

Service Code	HCPCS 71030
Hospital Charge Code	2001048
Hospital Revenue Code	324
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

XR CARDIAC SERIES MIN 4 VWS

Facility

$354.45

Service Code	HCPCS 71030
Hospital Charge Code	2001048
Hospital Revenue Code	324
Min. Negotiated Rate	$46.08
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$106.33
Rate for Payer: Aetna Medicare Advantage	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.38
Rate for Payer: Cigna Commercial	$177.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.08
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.17
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR C-ARM FLUORO <1 hr

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2002137
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR C-ARM FLUORO <1 hr

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2002137
Hospital Revenue Code	320
Min. Negotiated Rate	$92.56
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	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
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 CATH PLACEMENT VEN 2ND LT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2004703
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VEN 2ND LT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2004703
Hospital Revenue Code	361
Min. Negotiated Rate	$379.47
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$875.70
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.47
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VEN 2ND RT

Facility

$2,919.00

Service Code	HCPCS 36012RT
Hospital Charge Code	2709018
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VEN 2ND RT

Facility

$2,919.00

Service Code	HCPCS 36012RT
Hospital Charge Code	2709018
Hospital Revenue Code	361
Min. Negotiated Rate	$379.47
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$875.70
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.47
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VENOUS 1STO

Facility

$414.45

Service Code	HCPCS 36011
Hospital Charge Code	2004695
Hospital Revenue Code	361
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$146.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR CATH PLACEMENT VENOUS 1STO

Facility

$414.45

Service Code	HCPCS 36011
Hospital Charge Code	2004695
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR CATH PLMNT VENOUS ORGAN SAM

Facility

$621.65

Service Code	HCPCS 36500
Hospital Charge Code	2004729
Hospital Revenue Code	361
Min. Negotiated Rate	$80.81
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$186.50
Rate for Payer: Aetna Medicare Advantage	$186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
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	$158.52
Rate for Payer: Cigna Commercial	$172.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.81
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.25
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR CATH PLMNT VENOUS ORGAN SAM

Facility

$621.65

Service Code	HCPCS 36500
Hospital Charge Code	2004729
Hospital Revenue Code	361
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$93.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.25

XR CEPHALOGRAM ORTHODONTIC

Facility

$258.70

Service Code	HCPCS 70350
Hospital Charge Code	2011317
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CEPHALOGRAM ORTHODONTIC

Facility

$258.70

Service Code	HCPCS 70350
Hospital Charge Code	2011317
Hospital Revenue Code	320
Min. Negotiated Rate	$18.10
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CERVICAL SPINE 4 VWS W OBL

Facility

$6,601.19

Service Code	HCPCS 72050
Hospital Charge Code	2002012
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CERVICAL SPINE 4 VWS W OBL

Facility

$6,601.19

Service Code	HCPCS 72050
Hospital Charge Code	2002012
Hospital Revenue Code	320
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

XR CERVICAL SPINE AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72040
Hospital Charge Code	2000651
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CERVICAL SPINE AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72040
Hospital Charge Code	2000651
Hospital Revenue Code	320
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Better Health Medicaid	$242.34
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19

XR CERVICAL SPINE COMP W/ F&E

Facility

$5,100.00

Service Code	HCPCS 72052
Hospital Charge Code	2002020
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CERVICAL SPINE COMP W/ F&E

Facility

$5,100.00

Service Code	HCPCS 72052
Hospital Charge Code	2002020
Hospital Revenue Code	320
Min. Negotiated Rate	$59.02
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
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	$59.02
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	$316.08

Know your out-of-pocket cost for care.

All Charges