Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR HIP RT 1 VIEW

Facility

$181.65

Hospital Charge Code	2000124
Hospital Revenue Code	320
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$54.49
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR HIP RT 1 VIEW

Facility

$181.65

Hospital Charge Code	2000124
Hospital Revenue Code	320
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

XR HIP RT 2 VIEWS

Facility

$250.00

Hospital Charge Code	2000108
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

XR HIP RT 2 VIEWS

Facility

$250.00

Hospital Charge Code	2000108
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR HUMERUS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7306050
Hospital Charge Code	2011348
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HUMERUS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7306050
Hospital Charge Code	2011348
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 HUMERUS MIN 2 VWS LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2000032
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HUMERUS MIN 2 VWS LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2000032
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 HUMERUS MIN 2 VWS RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	2000033
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 HUMERUS MIN 2 VWS RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	2000033
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HYSTEROSALPINGRAPH

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	2000826
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
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	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
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 HYSTEROSALPINGRAPH

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	2000826
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR IMA GUID PLCMT MET LOC CLIP

Facility

$400.35

Service Code	HCPCS 19282
Hospital Charge Code	2004735
Hospital Revenue Code	361
Min. Negotiated Rate	$60.05
Max. Negotiated Rate	$60.05
Rate for Payer: Qualcare PPO/HMO/WC	$60.05

XR IMA GUID PLCMT MET LOC CLIP

Facility

$400.35

Service Code	HCPCS 19282
Hospital Charge Code	2004735
Hospital Revenue Code	361
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$120.11
Rate for Payer: Aetna Medicare Advantage	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.09
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	$102.09
Rate for Payer: Cigna Commercial	$44.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.05
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.05
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INFANTOGRAM

Facility

$5,100.00

Service Code	HCPCS 77076
Hospital Charge Code	2002152
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR INFANTOGRAM

Facility

$5,100.00

Service Code	HCPCS 77076
Hospital Charge Code	2002152
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$32.50
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XR INJ/ASP RENAL CYST/PELVIS P

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2004836
Hospital Revenue Code	361
Min. Negotiated Rate	$612.29
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,412.97
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.29
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR INJ/ASP RENAL CYST/PELVIS P

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2004836
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

XR INJECTION FOR BRONCHUS XRAY

Facility

$2,480.00

Hospital Charge Code	2011220
Hospital Revenue Code	361
Min. Negotiated Rate	$322.40
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$744.00
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
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	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.40
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR INJECTION FOR BRONCHUS XRAY

Facility

$2,480.00

Hospital Charge Code	2011220
Hospital Revenue Code	361
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$529.88
Rate for Payer: Aetna Medicare Advantage	$529.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.39
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	$450.39
Rate for Payer: Cigna Commercial	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.61
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.94
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$264.94
Max. Negotiated Rate	$264.94
Rate for Payer: Qualcare PPO/HMO/WC	$264.94

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$264.94
Max. Negotiated Rate	$264.94
Rate for Payer: Qualcare PPO/HMO/WC	$264.94

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$529.88
Rate for Payer: Aetna Medicare Advantage	$529.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.39
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	$450.39
Rate for Payer: Cigna Commercial	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.61
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.94
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ HIP ARTHROGR W/O ANESTH

Facility

$414.45

Service Code	HCPCS 27093
Hospital Charge Code	2004299
Hospital Revenue Code	361
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$124.33
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$62.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

Know your out-of-pocket cost for care.

All Charges