Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ HYSTEROSALPING

Facility

$497.65

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$57.23
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$149.29
Rate for Payer: Aetna Medicare Advantage	$149.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.90
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	$126.90
Rate for Payer: Cigna Commercial	$57.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.69
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.65
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ HYSTEROSALPING

Facility

$497.65

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$74.65
Rate for Payer: Qualcare PPO/HMO/WC	$74.65

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.45

Service Code	HCPCS 50690
Hospital Charge Code	2004349
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.45

Service Code	HCPCS 50690
Hospital Charge Code	2004349
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	$68.04
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

XR INJ INTRAOP PANCREATOGRAPHY

Facility

$631.70

Service Code	HCPCS 48400
Hospital Charge Code	2011210
Hospital Revenue Code	361
Min. Negotiated Rate	$82.12
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$189.51
Rate for Payer: Aetna Medicare Advantage	$189.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.08
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	$161.08
Rate for Payer: Cigna Commercial	$102.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.12
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.75
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR INJ INTRAOP PANCREATOGRAPHY

Facility

$631.70

Service Code	HCPCS 48400
Hospital Charge Code	2011210
Hospital Revenue Code	361
Min. Negotiated Rate	$94.75
Max. Negotiated Rate	$94.75
Rate for Payer: Qualcare PPO/HMO/WC	$94.75

XR INJ MAJOR JNT ARTHROCENTESI

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2004936
Hospital Revenue Code	361
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$222.00
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
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	$188.70
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ MAJOR JNT ARTHROCENTESI

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2004936
Hospital Revenue Code	361
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

XR INJ MAJOR JOINT ARTHROCENT

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2011071
Hospital Revenue Code	361
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

XR INJ MAJOR JOINT ARTHROCENT

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2011071
Hospital Revenue Code	361
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$222.00
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
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	$188.70
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ PROC ANKLE ART

Facility

$414.45

Service Code	HCPCS 27648
Hospital Charge Code	2011301
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC ANKLE ART

Facility

$414.45

Service Code	HCPCS 27648
Hospital Charge Code	2011301
Hospital Revenue Code	361
Min. Negotiated Rate	$47.28
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	$47.28
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

XR INJ PROC CHOLANGIO T-TUBE

Facility

$414.45

Service Code	HCPCS 47505
Hospital Charge Code	2004653
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	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC CHOLANGIO T-TUBE

Facility

$414.45

Service Code	HCPCS 47505
Hospital Charge Code	2004653
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC CYSTOGRAPHY/VCU

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004844
Hospital Revenue Code	361
Min. Negotiated Rate	$40.33
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	$40.33
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

XR INJ PROC CYSTOGRAPHY/VCU

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004844
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROCEDURE GALACTOGRAM

Facility

$1,094.45

Service Code	HCPCS 19030
Hospital Charge Code	2004449
Hospital Revenue Code	361
Min. Negotiated Rate	$69.10
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$328.33
Rate for Payer: Aetna Medicare Advantage	$328.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.08
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	$279.08
Rate for Payer: Cigna Commercial	$69.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.28
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ PROCEDURE GALACTOGRAM

Facility

$1,094.45

Service Code	HCPCS 19030
Hospital Charge Code	2004449
Hospital Revenue Code	361
Min. Negotiated Rate	$164.17
Max. Negotiated Rate	$164.17
Rate for Payer: Qualcare PPO/HMO/WC	$164.17

XR INJ PROC ELBOW ARTHRO

Facility

$414.45

Service Code	HCPCS 24220
Hospital Charge Code	2011303
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	$60.55
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

XR INJ PROC ELBOW ARTHRO

Facility

$414.45

Service Code	HCPCS 24220
Hospital Charge Code	2011303
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC KNEE ARTHRO

Facility

$414.45

Service Code	HCPCS 27370
Hospital Charge Code	2004141
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC KNEE ARTHRO

Facility

$414.45

Service Code	HCPCS 27370
Hospital Charge Code	2004141
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	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC SHOULDER ARTHRO

Facility

$414.45

Service Code	HCPCS 23350
Hospital Charge Code	2004174
Hospital Revenue Code	361
Min. Negotiated Rate	$45.37
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	$45.37
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

XR INJ PROC SHOULDER ARTHRO

Facility

$414.45

Service Code	HCPCS 23350
Hospital Charge Code	2004174
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

Know your out-of-pocket cost for care.

All Charges