Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	321036593
Hospital Revenue Code	361
Min. Negotiated Rate	$786.58
Max. Negotiated Rate	$4,640.55
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
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	$3,944.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DEXA FOREARM BMD LT

Facility

$5,100.00

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117A
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DEXA FOREARM BMD LT

Facility

$5,100.00

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117A
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
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) 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 DEXA FOREARM BMD LT

Facility

$607.50

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117
Hospital Revenue Code	320
Min. Negotiated Rate	$78.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR DEXA FOREARM BMD LT

Facility

$607.50

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118A
Hospital Revenue Code	320
Min. Negotiated Rate	$78.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118A
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118
Hospital Revenue Code	320
Min. Negotiated Rate	$78.97
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109
Hospital Revenue Code	320
Min. Negotiated Rate	$121.55
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	$121.55
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 DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109A
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109A
Hospital Revenue Code	320
Min. Negotiated Rate	$121.55
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	$121.55
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 DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Hospital Charge Code	2000910
Hospital Revenue Code	401
Min. Negotiated Rate	$101.89
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$235.12
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.89
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Service Code	HCPCS G0204
Hospital Charge Code	94064033
Hospital Revenue Code	401
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Service Code	HCPCS G0204
Hospital Charge Code	94064033
Hospital Revenue Code	401
Min. Negotiated Rate	$101.89
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$235.12
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.89
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Hospital Charge Code	2000910
Hospital Revenue Code	401
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Hospital Charge Code	2000911
Hospital Revenue Code	403
Min. Negotiated Rate	$190.10
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$438.70
Rate for Payer: Aetna Medicare Advantage	$438.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.89
Rate for Payer: Cigna Commercial	$731.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.10
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$219.35
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Service Code	HCPCS G0202
Hospital Charge Code	94064029
Hospital Revenue Code	403
Min. Negotiated Rate	$219.35
Max. Negotiated Rate	$219.35
Rate for Payer: Qualcare PPO/HMO/WC	$219.35

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Service Code	HCPCS G0202
Hospital Charge Code	94064029
Hospital Revenue Code	403
Min. Negotiated Rate	$190.10
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$438.70
Rate for Payer: Aetna Medicare Advantage	$438.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.89
Rate for Payer: Cigna Commercial	$731.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.10
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$219.35
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Hospital Charge Code	2000911
Hospital Revenue Code	403
Min. Negotiated Rate	$219.35
Max. Negotiated Rate	$219.35
Rate for Payer: Qualcare PPO/HMO/WC	$219.35

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Hospital Charge Code	2000912
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Hospital Charge Code	2000912
Hospital Revenue Code	401
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$131.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.88
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Service Code	HCPCS G0206
Hospital Charge Code	94064035
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Service Code	HCPCS G0206
Hospital Charge Code	94064035
Hospital Revenue Code	401
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$131.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.88
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

Know your out-of-pocket cost for care.

All Charges