Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR CHEST PORTABLE

Facility

$278.45

Service Code	HCPCS 71010
Hospital Charge Code	2002772
Hospital Revenue Code	324
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$41.77
Rate for Payer: Qualcare PPO/HMO/WC	$41.77

XR CHEST SPECIAL VIEW

Facility

$258.70

Service Code	HCPCS 71035
Hospital Charge Code	2002319
Hospital Revenue Code	324
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$1,212.34
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59

XR CHEST SPECIAL VIEW

Facility

$258.70

Service Code	HCPCS 71035
Hospital Charge Code	2002319
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 STEREO FRONTAL

Facility

$258.70

Service Code	HCPCS 71015
Hospital Charge Code	2011323
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 STEREO FRONTAL

Facility

$258.70

Service Code	HCPCS 71015
Hospital Charge Code	2011323
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 W/APICAL

Facility

$448.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Aetna Commercial	$134.40
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.24
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

XR CHEST W/APICAL

Facility

$448.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

XR CHEST W/ OBLIQUE

Facility

$326.45

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

XR CHEST W/ OBLIQUE

Facility

$326.45

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$42.44
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$97.94
Rate for Payer: Aetna Medicare Advantage	$97.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.24
Rate for Payer: Cigna Commercial	$163.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.44
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CHOLAGIOGRAM PERC TRNSHPATC

Facility

$1,224.75

Service Code	HCPCS 74320
Hospital Charge Code	2011324
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$612.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CHOLAGIOGRAM PERC TRNSHPATC

Facility

$1,224.75

Service Code	HCPCS 74320
Hospital Charge Code	2011324
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$82.28
Max. Negotiated Rate	$2,550.00
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	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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 CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CISTRENOGRAPHY

Facility

$1,033.95

Service Code	HCPCS 70015
Hospital Charge Code	2011325
Hospital Revenue Code	320
Min. Negotiated Rate	$155.09
Max. Negotiated Rate	$155.09
Rate for Payer: Qualcare PPO/HMO/WC	$155.09

XR CISTRENOGRAPHY

Facility

$1,033.95

Service Code	HCPCS 70015
Hospital Charge Code	2011325
Hospital Revenue Code	320
Min. Negotiated Rate	$134.41
Max. Negotiated Rate	$1,866.82
Rate for Payer: Aetna Commercial	$310.19
Rate for Payer: Aetna Medicare Advantage	$310.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.66
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.41
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.09
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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

XR COCCYX

Facility

$627.25

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
Rate for Payer: Aetna Commercial	$188.18
Rate for Payer: Aetna Medicare Advantage	$188.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.95
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.54
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.09
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19

XR COCCYX

Facility

$627.25

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$94.09
Max. Negotiated Rate	$94.09
Rate for Payer: Qualcare PPO/HMO/WC	$94.09

XR COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$959.25

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$287.77
Rate for Payer: Aetna Medicare Advantage	$287.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.61
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	$244.61
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.89
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$959.25

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$143.89
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

Know your out-of-pocket cost for care.

All Charges