Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR FOOT RT 3RD DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T7
Hospital Charge Code	2001035
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 FOOT RT 4TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T8
Hospital Charge Code	2001040
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 FOOT RT 4TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T8
Hospital Charge Code	2001040
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FOOT RT 5TH DIGIT

Facility

$6,601.19

Service Code	HCPCS 73660T9
Hospital Charge Code	2001045
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 FOOT RT 5TH DIGIT

Facility

$6,601.19

Service Code	HCPCS 73660T9
Hospital Charge Code	2001045
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOOT RT GREAT TOE

Facility

$6,601.19

Service Code	HCPCS 73660T5
Hospital Charge Code	2001025
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 FOOT RT GREAT TOE

Facility

$6,601.19

Service Code	HCPCS 73660T5
Hospital Charge Code	2001025
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOREARM 2 VIEWS BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	2011342
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 FOREARM 2 VIEWS BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	2011342
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOREARM AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	2000057
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 FOREARM AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	2000057
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOREARM AP & LAT RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	2000058
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOREARM AP & LAT RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	2000058
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 FOREIGN BODY LOC EYE BILTRL

Facility

$753.70

Service Code	HCPCS 7003050
Hospital Charge Code	2011343
Hospital Revenue Code	320
Min. Negotiated Rate	$113.06
Max. Negotiated Rate	$113.06
Rate for Payer: Qualcare PPO/HMO/WC	$113.06

XR FOREIGN BODY LOC EYE BILTRL

Facility

$753.70

Service Code	HCPCS 7003050
Hospital Charge Code	2011343
Hospital Revenue Code	320
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$226.11
Rate for Payer: Aetna Medicare Advantage	$226.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.19
Rate for Payer: Cigna Commercial	$376.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.06
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR FOREIGN BODY SURVEY CHILD

Facility

$5,100.00

Service Code	HCPCS 76010
Hospital Charge Code	2002145
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FOREIGN BODY SURVEY CHILD

Facility

$5,100.00

Service Code	HCPCS 76010
Hospital Charge Code	2002145
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
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	$28.05
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

XR GB SCOUT - AP ABD

Facility

$281.65

Service Code	HCPCS 74000
Hospital Charge Code	2000339
Hospital Revenue Code	320
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

XR GB SCOUT - AP ABD

Facility

$281.65

Service Code	HCPCS 74000
Hospital Charge Code	2000339
Hospital Revenue Code	320
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19

XR GB SERIES

Facility

$562.45

Service Code	HCPCS 74290
Hospital Charge Code	2000271
Hospital Revenue Code	320
Min. Negotiated Rate	$84.37
Max. Negotiated Rate	$84.37
Rate for Payer: Qualcare PPO/HMO/WC	$84.37

XR GB SERIES

Facility

$562.45

Service Code	HCPCS 74290
Hospital Charge Code	2000271
Hospital Revenue Code	320
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$168.74
Rate for Payer: Aetna Medicare Advantage	$168.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.42
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR GI SERIES W/ AIR CONT

Facility

$925.65

Service Code	HCPCS 74247
Hospital Charge Code	2000230
Hospital Revenue Code	320
Min. Negotiated Rate	$138.85
Max. Negotiated Rate	$138.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.85

XR GI SERIES W/ AIR CONT

Facility

$925.65

Service Code	HCPCS 74247
Hospital Charge Code	2000230
Hospital Revenue Code	320
Min. Negotiated Rate	$120.33
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$277.69
Rate for Payer: Aetna Medicare Advantage	$277.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.04
Rate for Payer: Cigna Commercial	$462.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.33
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.85
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR GI SERIES W KUB

Facility

$6,601.19

Service Code	HCPCS 74241
Hospital Charge Code	2002046
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR GI SERIES W KUB

Facility

$6,601.19

Service Code	HCPCS 74241
Hospital Charge Code	2002046
Hospital Revenue Code	320
Min. Negotiated Rate	$399.88
Max. Negotiated Rate	$3,300.59
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) 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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

Know your out-of-pocket cost for care.

All Charges