Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR SPINE LS COMPLETE INC BEND

Facility

$5,100.00

Service Code	HCPCS 72114
Hospital Charge Code	2011110
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
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	$52.36
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 SPINE LS COMPLETE INC BEND

Facility

$5,100.00

Service Code	HCPCS 72114
Hospital Charge Code	2011110
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SPINE SCOLIOSIS SPNE & STND

Facility

$440.25

Hospital Charge Code	2011390
Hospital Revenue Code	320
Min. Negotiated Rate	$57.23
Max. Negotiated Rate	$1,489.00
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) PPO	$112.26
Rate for Payer: Cigna Commercial	$220.12
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

XR SPINE SCOLIOSIS SPNE & STND

Facility

$440.25

Hospital Charge Code	2011390
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 THORACIC AP & LAB SWI

Facility

$704.00

Service Code	HCPCS 72072
Hospital Charge Code	2011105
Hospital Revenue Code	320
Min. Negotiated Rate	$105.60
Max. Negotiated Rate	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.60

XR SPINE THORACIC AP & LAB SWI

Facility

$704.00

Service Code	HCPCS 72072
Hospital Charge Code	2011105
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$211.20
Rate for Payer: Aetna Medicare Advantage	$211.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.52
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	$179.52
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XR SPINE THORACOLUMBAR 2 VIEWS

Facility

$258.70

Service Code	HCPCS 72080
Hospital Charge Code	2011393
Hospital Revenue Code	320
Min. Negotiated Rate	$33.63
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	$35.55
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 THORACOLUMBAR 2 VIEWS

Facility

$258.70

Service Code	HCPCS 72080
Hospital Charge Code	2011393
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 THOR/LUM CHILD MIN 2V

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2002186
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SPINE THOR/LUM CHILD MIN 2V

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2002186
Hospital Revenue Code	320
Min. Negotiated Rate	$64.83
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	$64.83
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 SPLENOPORTOGRAM

Facility

$3,084.40

Service Code	HCPCS 75810
Hospital Charge Code	2011394
Hospital Revenue Code	320
Min. Negotiated Rate	$462.66
Max. Negotiated Rate	$462.66
Rate for Payer: Qualcare PPO/HMO/WC	$462.66

XR SPLENOPORTOGRAM

Facility

$3,084.40

Service Code	HCPCS 75810
Hospital Charge Code	2011394
Hospital Revenue Code	320
Min. Negotiated Rate	$116.88
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$925.32
Rate for Payer: Aetna Medicare Advantage	$925.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$786.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$786.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$786.52
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$462.66
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR SPNE CERVCAL CRSS-TBLE LTRL

Facility

$430.45

Service Code	HCPCS 72020
Hospital Charge Code	2011388
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 SPNE CERVCAL CRSS-TBLE LTRL

Facility

$430.45

Service Code	HCPCS 72020
Hospital Charge Code	2011388
Hospital Revenue Code	320
Min. Negotiated Rate	$64.57
Max. Negotiated Rate	$64.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.57

XR SPNE SNGLE VIEW SPECIFY LVL

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011391
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 SPNE SNGLE VIEW SPECIFY LVL

Facility

$258.70

Service Code	HCPCS 72020
Hospital Charge Code	2011391
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR SPNE THORACIC MINIMUM 4 VWS

Facility

$258.70

Service Code	HCPCS 72074
Hospital Charge Code	2011392
Hospital Revenue Code	320
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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	$46.75
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	$407.88

XR SPNE THORACIC MINIMUM 4 VWS

Facility

$258.70

Service Code	HCPCS 72074
Hospital Charge Code	2011392
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR STEREO BX PROBE

Facility

$1,488.00

Service Code	HCPCS 19081
Hospital Charge Code	2000926
Hospital Revenue Code	361
Min. Negotiated Rate	$193.44
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$446.40
Rate for Payer: Aetna Medicare Advantage	$446.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.44
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	$379.44
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.44
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.20
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR STEREO BX PROBE

Facility

$1,488.00

Service Code	HCPCS 19081
Hospital Charge Code	2000926
Hospital Revenue Code	361
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$223.20
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

XR STEREO LOC BREAST BX EACH

Facility

$1,872.50

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$280.88
Max. Negotiated Rate	$280.88
Rate for Payer: Qualcare PPO/HMO/WC	$280.88

XR STEREO LOC BREAST BX EACH

Facility

$1,872.50

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$243.43
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$561.75
Rate for Payer: Aetna Medicare Advantage	$561.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$477.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$477.49
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	$477.49
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.43
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.88
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
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	$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 STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
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