Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	2000915
Hospital Revenue Code	403
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$142.53
Rate for Payer: Qualcare PPO/HMO/WC	$142.53

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	94064031
Hospital Revenue Code	403
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$285.06
Rate for Payer: Aetna Medicare Advantage	$285.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.30
Rate for Payer: Cigna Commercial	$475.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.53
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.53
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	2000915
Hospital Revenue Code	403
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$285.06
Rate for Payer: Aetna Medicare Advantage	$285.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.30
Rate for Payer: Cigna Commercial	$475.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.53
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.53
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	94064031
Hospital Revenue Code	403
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$142.53
Rate for Payer: Qualcare PPO/HMO/WC	$142.53

XR DILATION PROC-ESOPHAGUS

Facility

$2,033.75

Service Code	HCPCS 74360
Hospital Charge Code	2004869
Hospital Revenue Code	320
Min. Negotiated Rate	$305.06
Max. Negotiated Rate	$305.06
Rate for Payer: Qualcare PPO/HMO/WC	$305.06

XR DILATION PROC-ESOPHAGUS

Facility

$2,033.75

Service Code	HCPCS 74360
Hospital Charge Code	2004869
Hospital Revenue Code	320
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$610.12
Rate for Payer: Aetna Medicare Advantage	$610.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$518.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$518.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$518.61
Rate for Payer: Cigna Commercial	$1,016.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.39
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$305.06
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR DISKOGRAPHY CERVICAL

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011329
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DISKOGRAPHY CERVICAL

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011329
Hospital Revenue Code	320
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$5,656.68
Rate for Payer: Aetna Better Health Medicaid	$5,545.76
Rate for Payer: Aetna Commercial	$1,294.69
Rate for Payer: Aetna Medicare Advantage	$1,294.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,100.49
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.03
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,656.68

XR DISKOGRAPHY LUMBAR

Facility

$4,315.65

Service Code	HCPCS 72295
Hospital Charge Code	2011330
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DISKOGRAPHY LUMBAR

Facility

$4,315.65

Service Code	HCPCS 72295
Hospital Charge Code	2011330
Hospital Revenue Code	320
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$4,650.22
Rate for Payer: Aetna Better Health Medicaid	$545.76
Rate for Payer: Aetna Commercial	$1,294.69
Rate for Payer: Aetna Medicare Advantage	$1,294.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,100.49
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.03
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$556.68

XR DISKOGRAPHY THORACIC

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011331
Hospital Revenue Code	320
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$5,656.68
Rate for Payer: Aetna Better Health Medicaid	$5,545.76
Rate for Payer: Aetna Commercial	$1,294.69
Rate for Payer: Aetna Medicare Advantage	$1,294.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,100.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,100.49
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.03
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,656.68

XR DISKOGRAPHY THORACIC

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011331
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DORSAL (THORACIC) SPINE

Facility

$6,601.19

Service Code	HCPCS 72070
Hospital Charge Code	2000669
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR DORSAL (THORACIC) SPINE

Facility

$6,601.19

Service Code	HCPCS 72070
Hospital Charge Code	2000669
Hospital Revenue Code	320
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$34.88
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	$407.88

XR DRAIN PELVIC ABSCESS PERC

Facility

$8,984.95

Hospital Charge Code	5600176
Hospital Revenue Code	361
Min. Negotiated Rate	$1,168.04
Max. Negotiated Rate	$4,492.48
Rate for Payer: Aetna Commercial	$2,695.49
Rate for Payer: Aetna Medicare Advantage	$2,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,291.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,291.16
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	$2,291.16
Rate for Payer: Cigna Commercial	$4,492.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,168.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.74

XR DRAIN PELVIC ABSCESS PERC

Facility

$8,984.95

Hospital Charge Code	5600176
Hospital Revenue Code	361
Min. Negotiated Rate	$1,347.74
Max. Negotiated Rate	$1,347.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.74

XR DRAW BLOOD OFF VENOUS DEVIC

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5600135
Hospital Revenue Code	361
Min. Negotiated Rate	$50.31
Max. Negotiated Rate	$50.31
Rate for Payer: Qualcare PPO/HMO/WC	$50.31

XR DRAW BLOOD OFF VENOUS DEVIC

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5600135
Hospital Revenue Code	361
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$100.62
Rate for Payer: Aetna Medicare Advantage	$100.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.53
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	$85.53
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.31
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR DUODENOGRAPHY HYPOTONIC

Facility

$813.75

Service Code	HCPCS 74260
Hospital Charge Code	2011332
Hospital Revenue Code	320
Min. Negotiated Rate	$122.06
Max. Negotiated Rate	$122.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.06

XR DUODENOGRAPHY HYPOTONIC

Facility

$813.75

Service Code	HCPCS 74260
Hospital Charge Code	2011332
Hospital Revenue Code	320
Min. Negotiated Rate	$105.79
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$244.12
Rate for Payer: Aetna Medicare Advantage	$244.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.51
Rate for Payer: Cigna Commercial	$406.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.79
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.06
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ECHO GUIDE FOR BIOPSY

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5600181
Hospital Revenue Code	361
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$329.28
Rate for Payer: Aetna Medicare Advantage	$329.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.89
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	$279.89
Rate for Payer: Cigna Commercial	$72.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.69
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

XR ECHO GUIDE FOR BIOPSY

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5600181
Hospital Revenue Code	361
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

XR ELBOW 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7307050
Hospital Charge Code	2011333
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ELBOW 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7307050
Hospital Charge Code	2011333
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 ELBOW COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7308050
Hospital Charge Code	2011334
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges