Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR SALIVARY GLND CALCULUS RGHT

Facility

$258.70

Service Code	HCPCS 70380
Hospital Charge Code	2011380
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SALIVRY GLND CALCULUS BLTRL

Facility

$258.70

Service Code	HCPCS 70380
Hospital Charge Code	2011379
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 SALIVRY GLND CALCULUS BLTRL

Facility

$258.70

Service Code	HCPCS 70380
Hospital Charge Code	2011379
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SCANOGRAM BONE LENGTH STUDY

Facility

$607.50

Service Code	HCPCS 77073
Hospital Charge Code	2002079
Hospital Revenue Code	320
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$182.25
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR SCANOGRAM BONE LENGTH STUDY

Facility

$607.50

Service Code	HCPCS 77073
Hospital Charge Code	2002079
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR SCAPULA BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7301050
Hospital Charge Code	2011381
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SCAPULA BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7301050
Hospital Charge Code	2011381
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 SCAPULA LT

Facility

$5,100.00

Service Code	HCPCS 73010LT
Hospital Charge Code	2002244
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 SCAPULA LT

Facility

$5,100.00

Service Code	HCPCS 73010LT
Hospital Charge Code	2002244
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SCAPULA RT COMPL

Facility

$5,100.00

Service Code	HCPCS 73010RT
Hospital Charge Code	2002245
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SCAPULA RT COMPL

Facility

$5,100.00

Service Code	HCPCS 73010RT
Hospital Charge Code	2002245
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 SCOLIOSIS SERIES ERECT ONLY

Facility

$442.45

Hospital Charge Code	2001022
Hospital Revenue Code	320
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

XR SCOLIOSIS SERIES ERECT ONLY

Facility

$442.45

Hospital Charge Code	2001022
Hospital Revenue Code	320
Min. Negotiated Rate	$57.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$132.74
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$221.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	7411494
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	411037186
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	411037186
Hospital Revenue Code	361
Min. Negotiated Rate	$233.81
Max. Negotiated Rate	$5,492.34
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$233.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	366837186
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	7411494
Hospital Revenue Code	361
Min. Negotiated Rate	$233.81
Max. Negotiated Rate	$5,492.34
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$233.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	321037186
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	366837186
Hospital Revenue Code	361
Min. Negotiated Rate	$233.81
Max. Negotiated Rate	$5,492.34
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$233.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	321037186
Hospital Revenue Code	361
Min. Negotiated Rate	$233.81
Max. Negotiated Rate	$3,638.70
Rate for Payer: Aetna Commercial	$3,638.70
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$233.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,576.77
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$233.81
Max. Negotiated Rate	$3,638.70
Rate for Payer: Aetna Commercial	$3,638.70
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$233.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,576.77
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

XR SELLA TURCICA

Facility

$376.85

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$113.06
Rate for Payer: Aetna Medicare Advantage	$113.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.10
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	$96.10
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.53
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SELLA TURCICA

Facility

$376.85

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$56.53
Rate for Payer: Qualcare PPO/HMO/WC	$56.53

Know your out-of-pocket cost for care.

All Charges