Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR LUMBOSACRAL SPINE W/ OBLIQ

Facility

$5,151.86

Service Code	HCPCS 72110
Hospital Charge Code	2002038
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,545.56
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$1,545.56
Rate for Payer: Aetna Medicare Advantage	$1,545.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.72
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$669.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$772.78
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XR MAM DIG FILM RADIOGR IMAGES

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002585
Hospital Revenue Code	403
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAM DIG FILM RADIOGR IMAGES

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002585
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR MAMMO DUOTOGRAM/GALA MULT

Facility

$822.50

Service Code	HCPCS 77054
Hospital Charge Code	2002583
Hospital Revenue Code	320
Min. Negotiated Rate	$123.38
Max. Negotiated Rate	$123.38
Rate for Payer: Qualcare PPO/HMO/WC	$123.38

XR MAMMO DUOTOGRAM/GALA MULT

Facility

$822.50

Service Code	HCPCS 77054
Hospital Charge Code	2002583
Hospital Revenue Code	320
Min. Negotiated Rate	$106.92
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna Medicare Advantage	$246.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.74
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.92
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.38
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR MAMMO DUOTOGRAM/GALA SNGL

Facility

$822.50

Service Code	HCPCS 77053
Hospital Charge Code	2002584
Hospital Revenue Code	320
Min. Negotiated Rate	$123.38
Max. Negotiated Rate	$123.38
Rate for Payer: Qualcare PPO/HMO/WC	$123.38

XR MAMMO DUOTOGRAM/GALA SNGL

Facility

$822.50

Service Code	HCPCS 77053
Hospital Charge Code	2002584
Hospital Revenue Code	320
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$246.75
Rate for Payer: Aetna Medicare Advantage	$246.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.74
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.92
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.38
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR MAMMOGRAPHY SCREEN BI

Facility

$434.40

Service Code	HCPCS 77057
Hospital Charge Code	2000917
Hospital Revenue Code	403
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$130.32
Rate for Payer: Aetna Medicare Advantage	$130.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.77
Rate for Payer: Cigna Commercial	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.47
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.16
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAMMOGRAPHY SCREEN BI

Facility

$434.40

Service Code	HCPCS 77057
Hospital Charge Code	2000917
Hospital Revenue Code	403
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$65.16
Rate for Payer: Qualcare PPO/HMO/WC	$65.16

XR MAMMOGRAPHY SCREEN UNI

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2000628
Hospital Revenue Code	401
Min. Negotiated Rate	$101.08
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$233.25
Rate for Payer: Aetna Medicare Advantage	$233.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.26
Rate for Payer: Cigna Commercial	$388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.08
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.62
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAMMOGRAPHY SCREEN UNI

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2000628
Hospital Revenue Code	401
Min. Negotiated Rate	$116.62
Max. Negotiated Rate	$116.62
Rate for Payer: Qualcare PPO/HMO/WC	$116.62

XR MAMMOGRAPHY UNILATERAL

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2000924
Hospital Revenue Code	401
Min. Negotiated Rate	$116.62
Max. Negotiated Rate	$116.62
Rate for Payer: Qualcare PPO/HMO/WC	$116.62

XR MAMMOGRAPHY UNILATERAL

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2000924
Hospital Revenue Code	401
Min. Negotiated Rate	$101.08
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$233.25
Rate for Payer: Aetna Medicare Advantage	$233.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.26
Rate for Payer: Cigna Commercial	$388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.08
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.62
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAMMOGRAPHY UNILATERAL

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	94064047
Hospital Revenue Code	401
Min. Negotiated Rate	$116.62
Max. Negotiated Rate	$116.62
Rate for Payer: Qualcare PPO/HMO/WC	$116.62

XR MAMMOGRAPHY UNILATERAL

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	94064047
Hospital Revenue Code	401
Min. Negotiated Rate	$101.08
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$233.25
Rate for Payer: Aetna Medicare Advantage	$233.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.26
Rate for Payer: Cigna Commercial	$388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.08
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.62
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAMO SCREEN TO DIAGNOSTIC

Facility

$434.40

Service Code	HCPCS 77057
Hospital Charge Code	2000918
Hospital Revenue Code	403
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$130.32
Rate for Payer: Aetna Medicare Advantage	$130.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.77
Rate for Payer: Cigna Commercial	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.47
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.16
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

XR MAMO SCREEN TO DIAGNOSTIC

Facility

$434.40

Service Code	HCPCS 77057
Hospital Charge Code	2000918
Hospital Revenue Code	403
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$65.16
Rate for Payer: Qualcare PPO/HMO/WC	$65.16

XR MANDIBLE

Facility

$5,100.00

Service Code	HCPCS 70110
Hospital Charge Code	2000354
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,627.00
Rate for Payer: Aetna Better Health Medicaid	$1,595.10
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	$37.40
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	$1,627.00

XR MANDIBLE

Facility

$5,100.00

Service Code	HCPCS 70110
Hospital Charge Code	2000354
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR MANDIBLE PARTIAL < 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70100
Hospital Charge Code	2011080
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR MANDIBLE PARTIAL < 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70100
Hospital Charge Code	2011080
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$30.86
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR MANUAL STRESS APPLIC-JOINT

Facility

$259.80

Service Code	HCPCS 77071
Hospital Charge Code	2011359
Hospital Revenue Code	320
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$38.97
Rate for Payer: Qualcare PPO/HMO/WC	$38.97

XR MANUAL STRESS APPLIC-JOINT

Facility

$259.80

Service Code	HCPCS 77071
Hospital Charge Code	2011359
Hospital Revenue Code	320
Min. Negotiated Rate	$23.06
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.94
Rate for Payer: Aetna Medicare Advantage	$77.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.25
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.97
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR MASTOIDS <3 VIEWS BILATERAL

Facility

$517.40

Service Code	HCPCS 7012050
Hospital Charge Code	2011360
Hospital Revenue Code	320
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$77.61
Rate for Payer: Qualcare PPO/HMO/WC	$77.61

XR MASTOIDS <3 VIEWS BILATERAL

Facility

$517.40

Service Code	HCPCS 7012050
Hospital Charge Code	2011360
Hospital Revenue Code	320
Min. Negotiated Rate	$67.26
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$155.22
Rate for Payer: Aetna Medicare Advantage	$155.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.94
Rate for Payer: Cigna Commercial	$258.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.61
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges