Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR CERVICAL SPINE PORTABLE

Facility

$5,100.00

Service Code	HCPCS 72020
Hospital Charge Code	2002798
Hospital Revenue Code	320
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$22.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
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	$216.59

XR CERVICAL SPINE PORTABLE

Facility

$5,100.00

Service Code	HCPCS 72020
Hospital Charge Code	2002798
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CHANGE G TUBE TO G-J PERC

Facility

$3,929.65

Service Code	HCPCS 49446
Hospital Charge Code	5600162
Hospital Revenue Code	361
Min. Negotiated Rate	$589.45
Max. Negotiated Rate	$589.45
Rate for Payer: Qualcare PPO/HMO/WC	$589.45

XR CHANGE G TUBE TO G-J PERC

Facility

$3,929.65

Service Code	HCPCS 49446
Hospital Charge Code	5600162
Hospital Revenue Code	361
Min. Negotiated Rate	$510.85
Max. Negotiated Rate	$4,569.67
Rate for Payer: Aetna Commercial	$1,178.89
Rate for Payer: Aetna Medicare Advantage	$1,178.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.06
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	$1,002.06
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.85
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$589.45
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR CHANGE OF URETER TUBE/STENT

Facility

$7,084.55

Service Code	HCPCS 50688
Hospital Charge Code	7411616
Hospital Revenue Code	361
Min. Negotiated Rate	$920.99
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$2,125.36
Rate for Payer: Aetna Medicare Advantage	$2,125.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,806.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,806.56
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	$1,806.56
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.99
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.68
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR CHANGE OF URETER TUBE/STENT

Facility

$7,084.55

Service Code	HCPCS 50688
Hospital Charge Code	5600174
Hospital Revenue Code	361
Min. Negotiated Rate	$1,062.68
Max. Negotiated Rate	$1,062.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.68

XR CHANGE OF URETER TUBE/STENT

Facility

$7,084.55

Service Code	HCPCS 50688
Hospital Charge Code	7411616
Hospital Revenue Code	361
Min. Negotiated Rate	$1,062.68
Max. Negotiated Rate	$1,062.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.68

XR CHANGE OF URETER TUBE/STENT

Facility

$7,084.55

Service Code	HCPCS 50688
Hospital Charge Code	5600174
Hospital Revenue Code	361
Min. Negotiated Rate	$920.99
Max. Negotiated Rate	$4,978.04
Rate for Payer: Aetna Commercial	$2,125.36
Rate for Payer: Aetna Medicare Advantage	$2,125.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,806.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,806.56
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	$1,806.56
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$920.99
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.68
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR CHANGE URETER STENT PERCUT

Facility

$11,620.55

Service Code	HCPCS 50382
Hospital Charge Code	5600167
Hospital Revenue Code	361
Min. Negotiated Rate	$1,743.08
Max. Negotiated Rate	$1,743.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.08

XR CHANGE URETER STENT PERCUT

Facility

$11,620.55

Service Code	HCPCS 50382
Hospital Charge Code	5600167
Hospital Revenue Code	361
Min. Negotiated Rate	$1,510.67
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$3,486.16
Rate for Payer: Aetna Medicare Advantage	$3,486.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,963.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,963.24
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	$2,963.24
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,510.67
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.08
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

XR CHEMICAL PLEURODESIS

Facility

$2,422.50

Service Code	HCPCS 32560
Hospital Charge Code	5600107
Hospital Revenue Code	361
Min. Negotiated Rate	$314.93
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$726.75
Rate for Payer: Aetna Medicare Advantage	$726.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.74
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	$617.74
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.93
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.38
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR CHEMICAL PLEURODESIS

Facility

$2,422.50

Service Code	HCPCS 32560
Hospital Charge Code	5600107
Hospital Revenue Code	361
Min. Negotiated Rate	$363.38
Max. Negotiated Rate	$363.38
Rate for Payer: Qualcare PPO/HMO/WC	$363.38

XR CHEST 2 VIEWS W/FLUOROSCOPY

Facility

$471.30

Service Code	HCPCS 71023
Hospital Charge Code	2011318
Hospital Revenue Code	324
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

XR CHEST 2 VIEWS W/FLUOROSCOPY

Facility

$471.30

Service Code	HCPCS 71023
Hospital Charge Code	2011318
Hospital Revenue Code	324
Min. Negotiated Rate	$61.27
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: Aetna Medicare Advantage	$141.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.18
Rate for Payer: Cigna Commercial	$235.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.27
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CHEST 4 OR > VIEWS

Facility

$5,100.00

Service Code	HCPCS 71048
Hospital Charge Code	2000552
Hospital Revenue Code	324
Min. Negotiated Rate	$48.26
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	$48.26
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

XR CHEST 4 OR > VIEWS

Facility

$5,100.00

Service Code	HCPCS 71048
Hospital Charge Code	2000552
Hospital Revenue Code	324
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CHEST DECUBITUS BILATERAL

Facility

$517.40

Service Code	HCPCS 7103550
Hospital Charge Code	2011319
Hospital Revenue Code	324
Min. Negotiated Rate	$67.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$155.22
Rate for Payer: Aetna Medicare Advantage	$155.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.94
Rate for Payer: Cigna Commercial	$258.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.61
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CHEST DECUBITUS BILATERAL

Facility

$517.40

Service Code	HCPCS 7103550
Hospital Charge Code	2011319
Hospital Revenue Code	324
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$77.61
Rate for Payer: Qualcare PPO/HMO/WC	$77.61

XR CHEST DECUBITUS LEFT

Facility

$258.70

Service Code	HCPCS 71035LT
Hospital Charge Code	2011320
Hospital Revenue Code	324
Min. Negotiated Rate	$33.63
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) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
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 CHEST DECUBITUS LEFT

Facility

$258.70

Service Code	HCPCS 71035LT
Hospital Charge Code	2011320
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST DECUBITUS RIGHT

Facility

$258.70

Service Code	HCPCS 71035RT
Hospital Charge Code	2011321
Hospital Revenue Code	324
Min. Negotiated Rate	$33.63
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) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
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 CHEST DECUBITUS RIGHT

Facility

$258.70

Service Code	HCPCS 71035RT
Hospital Charge Code	2011321
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST MIN 4 VIEW W/FLURSCPY

Facility

$471.30

Service Code	HCPCS 71034
Hospital Charge Code	2011322
Hospital Revenue Code	324
Min. Negotiated Rate	$61.27
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: Aetna Medicare Advantage	$141.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.18
Rate for Payer: Cigna Commercial	$235.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.27
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CHEST MIN 4 VIEW W/FLURSCPY

Facility

$471.30

Service Code	HCPCS 71034
Hospital Charge Code	2011322
Hospital Revenue Code	324
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

XR CHEST PORTABLE

Facility

$278.45

Service Code	HCPCS 71010
Hospital Charge Code	2002772
Hospital Revenue Code	324
Min. Negotiated Rate	$36.20
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$1,212.34
Rate for Payer: Aetna Commercial	$83.53
Rate for Payer: Aetna Medicare Advantage	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.00
Rate for Payer: Cigna Commercial	$139.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.77
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59

Know your out-of-pocket cost for care.

All Charges