Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR INJ PROC SIALOGRAPHY

Facility

$414.45

Service Code	HCPCS 42550
Hospital Charge Code	2004646
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 SIALOGRAPHY

Facility

$414.45

Service Code	HCPCS 42550
Hospital Charge Code	2004646
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	$56.12
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 URETHROCSTOGRAPHY

Facility

$414.45

Service Code	HCPCS 51610
Hospital Charge Code	2004901
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	$63.36
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 URETHROCSTOGRAPHY

Facility

$414.45

Service Code	HCPCS 51610
Hospital Charge Code	2004901
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 WRIST ARTHRO

Facility

$414.45

Service Code	HCPCS 25246
Hospital Charge Code	2004166
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	$66.29
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 WRIST ARTHRO

Facility

$414.45

Service Code	HCPCS 25246
Hospital Charge Code	2004166
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 SPINE CERV C1-C2 MYELO

Facility

$3,257.25

Service Code	HCPCS 61055
Hospital Charge Code	2004612
Hospital Revenue Code	361
Min. Negotiated Rate	$423.44
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$977.17
Rate for Payer: Aetna Medicare Advantage	$977.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.60
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	$830.60
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.44
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$488.59
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ SPINE CERV C1-C2 MYELO

Facility

$3,257.25

Service Code	HCPCS 61055
Hospital Charge Code	2004612
Hospital Revenue Code	361
Min. Negotiated Rate	$488.59
Max. Negotiated Rate	$488.59
Rate for Payer: Qualcare PPO/HMO/WC	$488.59

XR INJ SPINE LUMBAR DIAGNOSTIC

Facility

$2,035.90

Service Code	HCPCS 62270
Hospital Charge Code	2004380
Hospital Revenue Code	361
Min. Negotiated Rate	$264.67
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$610.77
Rate for Payer: Aetna Medicare Advantage	$610.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$519.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$519.15
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	$519.15
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.67
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$305.38
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR INJ SPINE LUMBAR DIAGNOSTIC

Facility

$2,035.90

Service Code	HCPCS 62270
Hospital Charge Code	2004380
Hospital Revenue Code	361
Min. Negotiated Rate	$305.38
Max. Negotiated Rate	$305.38
Rate for Payer: Qualcare PPO/HMO/WC	$305.38

XR INJ SPINE LUMBAR MYELO

Facility

$497.65

Service Code	HCPCS 62284
Hospital Charge Code	2004398
Hospital Revenue Code	361
Min. Negotiated Rate	$64.69
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	$77.95
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 SPINE LUMBAR MYELO

Facility

$497.65

Service Code	HCPCS 62284
Hospital Charge Code	2004398
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 VCUG

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004356
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 VCUG

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004356
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 W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	321036598
Hospital Revenue Code	361
Min. Negotiated Rate	$164.41
Max. Negotiated Rate	$164.41
Rate for Payer: Qualcare PPO/HMO/WC	$164.41

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	7411478
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	5600140
Hospital Revenue Code	361
Min. Negotiated Rate	$164.41
Max. Negotiated Rate	$164.41
Rate for Payer: Qualcare PPO/HMO/WC	$164.41

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	7411478
Hospital Revenue Code	361
Min. Negotiated Rate	$144.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$334.15
Rate for Payer: Aetna Medicare Advantage	$334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.03
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	$284.03
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	5600140
Hospital Revenue Code	361
Min. Negotiated Rate	$142.49
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$328.83
Rate for Payer: Aetna Medicare Advantage	$328.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.51
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	$279.51
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.49
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.41
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	366836598
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	366836598
Hospital Revenue Code	361
Min. Negotiated Rate	$144.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$334.15
Rate for Payer: Aetna Medicare Advantage	$334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.03
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	$284.03
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	411036598
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	411036598
Hospital Revenue Code	361
Min. Negotiated Rate	$144.80
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$334.15
Rate for Payer: Aetna Medicare Advantage	$334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.03
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	$284.03
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	321036598
Hospital Revenue Code	361
Min. Negotiated Rate	$142.49
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$328.83
Rate for Payer: Aetna Medicare Advantage	$328.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.51
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	$279.51
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.49
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.41
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR INSERT ABDOM DRAIN PERM

Facility

$13,564.25

Service Code	HCPCS 49421
Hospital Charge Code	5600157
Hospital Revenue Code	361
Min. Negotiated Rate	$2,034.64
Max. Negotiated Rate	$2,034.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,034.64

Know your out-of-pocket cost for care.

All Charges