Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	2011383
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	2011383
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHOULDER LT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020LT
Hospital Charge Code	2002400
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER LT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020LT
Hospital Charge Code	2002400
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHOULDER MIN 2 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	2000024
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER MIN 2 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	2000024
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHOULDER MIN 2 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	2000025
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER MIN 2 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	2000025
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHOULDER RT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	2002401
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER RT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	2002401
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
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) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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 SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	404675809
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	404675809
Hospital Revenue Code	320
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	2011384
Hospital Revenue Code	320
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$180.60
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	2011384
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR SIALOGRAM

Facility

$802.45

Service Code	HCPCS 70390
Hospital Charge Code	2001311
Hospital Revenue Code	320
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$240.74
Rate for Payer: Aetna Medicare Advantage	$240.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.62
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.32
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.37
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SIALOGRAM

Facility

$802.45

Service Code	HCPCS 70390
Hospital Charge Code	2001311
Hospital Revenue Code	320
Min. Negotiated Rate	$120.37
Max. Negotiated Rate	$120.37
Rate for Payer: Qualcare PPO/HMO/WC	$120.37

XR SINUS 2 VIEW

Facility

$5,100.00

Service Code	HCPCS 70210
Hospital Charge Code	2002178
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SINUS 2 VIEW

Facility

$5,100.00

Service Code	HCPCS 70210
Hospital Charge Code	2002178
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
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	$37.40
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 SINUS >=3VIEWS

Facility

$5,100.00

Service Code	HCPCS 70220
Hospital Charge Code	2000388
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
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	$51.42
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 SINUS >=3VIEWS

Facility

$5,100.00

Service Code	HCPCS 70220
Hospital Charge Code	2000388
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SKULL 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	2002467
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SKULL 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	2002467
Hospital Revenue Code	320
Min. Negotiated Rate	$35.21
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	$35.21
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 SKULL 4 VIEWS

Facility

$5,100.00

Service Code	HCPCS 70260
Hospital Charge Code	2000396
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges