Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR TMJ OPEN AND CLOSED RIGHT

Facility

$258.70

Service Code	HCPCS 70328
Hospital Charge Code	2011401
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 RIGHT

Facility

$258.70

Service Code	HCPCS 70328
Hospital Charge Code	2011401
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR TOE

Facility

$306.45

Service Code	HCPCS 73660
Hospital Charge Code	2000172
Hospital Revenue Code	320
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$91.94
Rate for Payer: Aetna Medicare Advantage	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.14
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.84
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.97
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

XR TOE

Facility

$306.45

Service Code	HCPCS 73660
Hospital Charge Code	2000172
Hospital Revenue Code	320
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.97

XR TOMOGRAPHY

Facility

$635.25

Service Code	HCPCS 76100
Hospital Charge Code	2000933
Hospital Revenue Code	320
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$190.57
Rate for Payer: Aetna Medicare Advantage	$190.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.99
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.58
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.29
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR TOMOGRAPHY

Facility

$635.25

Service Code	HCPCS 76100
Hospital Charge Code	2000933
Hospital Revenue Code	320
Min. Negotiated Rate	$95.29
Max. Negotiated Rate	$95.29
Rate for Payer: Qualcare PPO/HMO/WC	$95.29

XR TOMOGRPHY CMPLX MOTION BLTL

Facility

$1,224.75

Service Code	HCPCS 76102
Hospital Charge Code	2011402
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR TOMOGRPHY CMPLX MOTION BLTL

Facility

$1,224.75

Service Code	HCPCS 76102
Hospital Charge Code	2011402
Hospital Revenue Code	320
Min. Negotiated Rate	$159.22
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$367.43
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$612.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR TOMOGRPHY CMPLX MOTION LEFT

Facility

$602.00

Service Code	HCPCS 76101
Hospital Charge Code	2011403
Hospital Revenue Code	320
Min. Negotiated Rate	$78.26
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) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
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 TOMOGRPHY CMPLX MOTION LEFT

Facility

$602.00

Service Code	HCPCS 76101
Hospital Charge Code	2011403
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR TOMOGRPHY CMPLX MOTION RGHT

Facility

$602.00

Service Code	HCPCS 76101
Hospital Charge Code	2011404
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR TOMOGRPHY CMPLX MOTION RGHT

Facility

$602.00

Service Code	HCPCS 76101
Hospital Charge Code	2011404
Hospital Revenue Code	320
Min. Negotiated Rate	$78.26
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) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
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 TOMOGRPHY SINGLE PLANE LEFT

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011406
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) NJ Health	$65.45
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

XR TOMOGRPHY SINGLE PLANE LEFT

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011406
Hospital Revenue Code	320
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$66.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.04

XR TOMOGRPHY SINGLE PLANE RGHT

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011407
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) NJ Health	$65.45
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

XR TOMOGRPHY SINGLE PLANE RGHT

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011407
Hospital Revenue Code	320
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$66.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.04

XR TOMOGRPHY SNGL PLANE BILTRL

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011405
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) NJ Health	$65.45
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

XR TOMOGRPHY SNGL PLANE BILTRL

Facility

$440.25

Service Code	HCPCS 76100
Hospital Charge Code	2011405
Hospital Revenue Code	320
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$66.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.04

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	7411405
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	7411405
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	5600109
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$6,588.69
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	5600109
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANSCATHETER THEARPY INFUS

Facility

$7,142.25

Hospital Charge Code	5600145
Hospital Revenue Code	361
Min. Negotiated Rate	$928.49
Max. Negotiated Rate	$3,571.12
Rate for Payer: Aetna Commercial	$2,142.68
Rate for Payer: Aetna Medicare Advantage	$2,142.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,821.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,821.27
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	$1,821.27
Rate for Payer: Cigna Commercial	$3,571.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$928.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34

XR TRANSCATHETER THEARPY INFUS

Facility

$7,142.25

Hospital Charge Code	5600145
Hospital Revenue Code	361
Min. Negotiated Rate	$1,071.34
Max. Negotiated Rate	$1,071.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34

XR TRANSCATH IV STENT OPEN

Facility

$41,896.20

Hospital Charge Code	5600146
Hospital Revenue Code	361
Min. Negotiated Rate	$6,284.43
Max. Negotiated Rate	$6,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,284.43

Know your out-of-pocket cost for care.

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