Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR RIBS 2 VIEWS LEFT

Facility

$258.70

Service Code	HCPCS 71100
Hospital Charge Code	2011376
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR RIBS 2 VIEWS LEFT

Facility

$258.70

Service Code	HCPCS 71100
Hospital Charge Code	2011376
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
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	$65.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR RIBS 2 VIEWS RIGHT

Facility

$258.70

Service Code	HCPCS 71100
Hospital Charge Code	2011377
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
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	$65.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR RIBS 2 VIEWS RIGHT

Facility

$258.70

Service Code	HCPCS 71100
Hospital Charge Code	2011377
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR RIBS BI

Facility

$5,100.00

Service Code	HCPCS 71110
Hospital Charge Code	2000578
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
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	$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

XR RIBS BI

Facility

$5,100.00

Service Code	HCPCS 71110
Hospital Charge Code	2000578
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR RIBS BI INCL AP

Facility

$5,100.00

Service Code	HCPCS 71111
Hospital Charge Code	2011100
Hospital Revenue Code	320
Min. Negotiated Rate	$65.45
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	$65.45
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

XR RIBS BI INCL AP

Facility

$5,100.00

Service Code	HCPCS 71111
Hospital Charge Code	2011100
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR RIBS LEFT & PA CHEST

Facility

$6,601.19

Service Code	HCPCS 71101
Hospital Charge Code	2011142
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,980.36
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) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$248.96
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 RIBS LEFT & PA CHEST

Facility

$6,601.19

Service Code	HCPCS 71101
Hospital Charge Code	2011142
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR RIBS RIGHT & PA CHEST

Facility

$6,601.19

Service Code	HCPCS 71101
Hospital Charge Code	2011145
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,980.36
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) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$248.96
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 RIBS RIGHT & PA CHEST

Facility

$6,601.19

Service Code	HCPCS 71101
Hospital Charge Code	2011145
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR RIBS UNI

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2000560
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR RIBS UNI

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2000560
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 SACROILIAC JOINTS 1-2 VIEWS

Facility

$258.70

Service Code	HCPCS 72200
Hospital Charge Code	2011378
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SACROILIAC JOINTS 1-2 VIEWS

Facility

$258.70

Service Code	HCPCS 72200
Hospital Charge Code	2011378
Hospital Revenue Code	320
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.68
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
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	$65.97
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67

XR SACROILLIAC JOINTS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	2000990
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
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	$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	$316.08

XR SACROILLIAC JOINTS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	2000990
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SACRUM

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2001477
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SACRUM

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2001477
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
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	$247.19

XR SACRUM & COCCYX MIN 2 VWS

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2000693
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SACRUM & COCCYX MIN 2 VWS

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2000693
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$242.34
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	$247.19

XR SALIVARY GLAND FOR CALCULUS

Facility

$302.45

Service Code	HCPCS 70380
Hospital Charge Code	2004638
Hospital Revenue Code	320
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$45.37
Rate for Payer: Qualcare PPO/HMO/WC	$45.37

XR SALIVARY GLAND FOR CALCULUS

Facility

$302.45

Service Code	HCPCS 70380
Hospital Charge Code	2004638
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$90.73
Rate for Payer: Aetna Medicare Advantage	$90.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.12
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	$77.12
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.32
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SALIVARY GLND CALCULUS RGHT

Facility

$258.70

Service Code	HCPCS 70380
Hospital Charge Code	2011380
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
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	$65.97
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges