Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR SKULL 4 VIEWS

Facility

$5,100.00

Service Code	HCPCS 70260
Hospital Charge Code	2000396
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$51.42
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	$407.88

XR SKULL PORTABLE, LIMITED STU

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	2003002
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 PORTABLE, LIMITED STU

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	2003002
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 SMALL BOWEL SERIES

Facility

$5,100.00

Service Code	HCPCS 74250
Hospital Charge Code	2000255
Hospital Revenue Code	320
Min. Negotiated Rate	$71.77
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	$71.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$417.70
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 SMALL BOWEL SERIES

Facility

$5,100.00

Service Code	HCPCS 74250
Hospital Charge Code	2000255
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SM BOWEL-ENTEROCLYSIS TUBE

Facility

$1,631.25

Service Code	HCPCS 74251
Hospital Charge Code	2002392
Hospital Revenue Code	320
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$489.38
Rate for Payer: Aetna Medicare Advantage	$489.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.97
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.06
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SM BOWEL-ENTEROCLYSIS TUBE

Facility

$1,631.25

Service Code	HCPCS 74251
Hospital Charge Code	2002392
Hospital Revenue Code	320
Min. Negotiated Rate	$244.69
Max. Negotiated Rate	$244.69
Rate for Payer: Qualcare PPO/HMO/WC	$244.69

XR SPEECH THERAPY SWALLOW

Facility

$604.00

Service Code	HCPCS 74230
Hospital Charge Code	2002756
Hospital Revenue Code	320
Min. Negotiated Rate	$90.60
Max. Negotiated Rate	$90.60
Rate for Payer: Qualcare PPO/HMO/WC	$90.60

XR SPEECH THERAPY SWALLOW

Facility

$604.00

Service Code	HCPCS 74230
Hospital Charge Code	2002756
Hospital Revenue Code	320
Min. Negotiated Rate	$75.79
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$181.20
Rate for Payer: Aetna Medicare Advantage	$181.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.02
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SPINE 1 VIEW

Facility

$430.45

Service Code	HCPCS 72020
Hospital Charge Code	2002350
Hospital Revenue Code	320
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$129.13
Rate for Payer: Aetna Medicare Advantage	$129.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.76
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.96
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.57
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR SPINE 1 VIEW

Facility

$430.45

Service Code	HCPCS 72020
Hospital Charge Code	2002350
Hospital Revenue Code	320
Min. Negotiated Rate	$64.57
Max. Negotiated Rate	$64.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.57

XR SPINE 1 VIEW CERVICAL

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011385
Hospital Revenue Code	320
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$22.80
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR SPINE 1 VIEW CERVICAL

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011385
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SPINE 1 VIEW LUMBAR

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011386
Hospital Revenue Code	320
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$22.80
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR SPINE 1 VIEW LUMBAR

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011386
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SPINE 1 VIEW THORACIC

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011387
Hospital Revenue Code	320
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
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	$22.80
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR SPINE 1 VIEW THORACIC

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011387
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SPINE CRVCAL W/FLXT& OR/EXT

Facility

$440.25

Service Code	HCPCS 72052
Hospital Charge Code	2011389
Hospital Revenue Code	320
Min. Negotiated Rate	$57.23
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$132.07
Rate for Payer: Aetna Medicare Advantage	$132.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.26
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.23
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.04
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

XR SPINE CRVCAL W/FLXT& OR/EXT

Facility

$440.25

Service Code	HCPCS 72052
Hospital Charge Code	2011389
Hospital Revenue Code	320
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$66.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.04

XR SPINE ENTIRE

Facility

$1,051.25

Hospital Charge Code	2000644
Hospital Revenue Code	320
Min. Negotiated Rate	$136.66
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$315.38
Rate for Payer: Aetna Medicare Advantage	$315.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$268.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$268.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$268.07
Rate for Payer: Cigna Commercial	$525.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.66
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SPINE ENTIRE

Facility

$1,051.25

Hospital Charge Code	2000644
Hospital Revenue Code	320
Min. Negotiated Rate	$157.69
Max. Negotiated Rate	$157.69
Rate for Payer: Qualcare PPO/HMO/WC	$157.69

XR SPINE LS AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72100
Hospital Charge Code	2000677
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SPINE LS AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72100
Hospital Charge Code	2000677
Hospital Revenue Code	320
Min. Negotiated Rate	$41.14
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$41.14
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XR SPINE LS BENDING ONLY MIN 4

Facility

$760.00

Service Code	HCPCS 72120
Hospital Charge Code	2011115
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
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	$193.80
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SPINE LS BENDING ONLY MIN 4

Facility

$760.00

Service Code	HCPCS 72120
Hospital Charge Code	2011115
Hospital Revenue Code	320
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

Know your out-of-pocket cost for care.

All Charges