Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
Hospital Revenue Code	320
Min. Negotiated Rate	$33.85
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	$33.85
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 TEETH COMPLETE FULL MOUTH

Facility

$284.35

Service Code	HCPCS 70320
Hospital Charge Code	2011396
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR TEETH COMPLETE FULL MOUTH

Facility

$284.35

Service Code	HCPCS 70320
Hospital Charge Code	2011396
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$801.35
Rate for Payer: Aetna Commercial	$85.31
Rate for Payer: Aetna Medicare Advantage	$85.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.51
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	$72.51
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$817.38

XR TEETH PARTIAL

Facility

$284.35

Service Code	HCPCS 70310
Hospital Charge Code	2011397
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR TEETH PARTIAL

Facility

$284.35

Service Code	HCPCS 70310
Hospital Charge Code	2011397
Hospital Revenue Code	320
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$7,747.00
Rate for Payer: Aetna Better Health Medicaid	$7,595.10
Rate for Payer: Aetna Commercial	$85.31
Rate for Payer: Aetna Medicare Advantage	$85.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.51
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,747.00

XR TEETH SINGLE VIEW

Facility

$284.35

Service Code	HCPCS 70300
Hospital Charge Code	2011398
Hospital Revenue Code	320
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$85.31
Rate for Payer: Aetna Medicare Advantage	$85.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.51
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR TEETH SINGLE VIEW

Facility

$284.35

Service Code	HCPCS 70300
Hospital Charge Code	2011398
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR THORACENTESIS FOR ASPIRATIO

Facility

$2,422.65

Hospital Charge Code	5600104
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR THORACENTESIS FOR ASPIRATIO

Facility

$2,422.65

Hospital Charge Code	5600104
Hospital Revenue Code	361
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$726.79
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$1,211.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.94
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR THORACENTESIS W IMAGING

Facility

$2,429.50

Service Code	HCPCS 32555
Hospital Charge Code	2004059
Hospital Revenue Code	361
Min. Negotiated Rate	$364.43
Max. Negotiated Rate	$364.43
Rate for Payer: Qualcare PPO/HMO/WC	$364.43

XR THORACENTESIS W IMAGING

Facility

$2,429.50

Service Code	HCPCS 32555
Hospital Charge Code	2004059
Hospital Revenue Code	361
Min. Negotiated Rate	$315.83
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$728.85
Rate for Payer: Aetna Medicare Advantage	$728.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$619.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$619.52
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	$619.52
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.83
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$364.43
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

XR THORACENTESIS,W/INSERTION

Facility

$370.00

Service Code	HCPCS 32002
Hospital Charge Code	2004067
Hospital Revenue Code	361
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$111.00
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
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	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.10
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

XR THORACENTESIS,W/INSERTION

Facility

$370.00

Service Code	HCPCS 32002
Hospital Charge Code	2004067
Hospital Revenue Code	361
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

XR THORACENTESIS W/TUBE INSERT

Facility

$2,422.65

Hospital Charge Code	5600105
Hospital Revenue Code	361
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$726.79
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$1,211.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.94
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR THORACENTESIS W/TUBE INSERT

Facility

$2,422.65

Hospital Charge Code	5600105
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR TIBIA & FIBULA AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	2000149
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR TIBIA & FIBULA AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	2000149
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 TIBIA & FIBULA AP & LAT RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	2000150
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR TIBIA & FIBULA AP & LAT RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	2000150
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 TIBIA/FIBULA BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	2011399
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR TIBIA/FIBULA BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	2011399
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 TMJ JOINT BI

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	2000479
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR TMJ JOINT BI

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	2000479
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 TMJ OPEN AND CLOSED LEFT

Facility

$258.70

Service Code	HCPCS 70328
Hospital Charge Code	2011400
Hospital Revenue Code	320
Min. Negotiated Rate	$27.51
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$1,212.34
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	$27.51
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	$1,236.59

XR TMJ OPEN AND CLOSED LEFT

Facility

$258.70

Service Code	HCPCS 70328
Hospital Charge Code	2011400
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

Know your out-of-pocket cost for care.

All Charges