Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR UPPER GI W/AIR CNTRST & KUB

Facility

$521.00

Service Code	HCPCS 74241
Hospital Charge Code	2011412
Hospital Revenue Code	320
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$78.15
Rate for Payer: Qualcare PPO/HMO/WC	$78.15

XR UPPER GI W/AIR CNTRST & KUB

Facility

$521.00

Service Code	HCPCS 74241
Hospital Charge Code	2011412
Hospital Revenue Code	320
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$156.30
Rate for Payer: Aetna Medicare Advantage	$156.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.85
Rate for Payer: Cigna Commercial	$260.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.73
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

XR UPPER GI W/ AIR CONTRAST

Facility

$521.00

Service Code	HCPCS 74246
Hospital Charge Code	2011411
Hospital Revenue Code	320
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$78.15
Rate for Payer: Qualcare PPO/HMO/WC	$78.15

XR UPPER GI W/ AIR CONTRAST

Facility

$521.00

Service Code	HCPCS 74246
Hospital Charge Code	2011411
Hospital Revenue Code	320
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$156.30
Rate for Payer: Aetna Medicare Advantage	$156.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.85
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.73
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UPPER GI W SCOUT DBLE CONTR

Facility

$5,100.00

Service Code	HCPCS 74246
Hospital Charge Code	404174246
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR UPPER GI W SCOUT DBLE CONTR

Facility

$5,100.00

Service Code	HCPCS 74246
Hospital Charge Code	404174246
Hospital Revenue Code	320
Min. Negotiated Rate	$96.25
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	$96.25
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 UPPER XTRMTY INFANT BILTRAL

Facility

$5,100.00

Service Code	HCPCS 7309250
Hospital Charge Code	2011409
Hospital Revenue Code	320
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$2,550.00
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) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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 UPPER XTRMTY INFANT BILTRAL

Facility

$5,100.00

Service Code	HCPCS 7309250
Hospital Charge Code	2011409
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR URETHROCYSTOGRAPHY

Facility

$5,100.00

Service Code	HCPCS 74455
Hospital Charge Code	2000784
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR URETHROCYSTOGRAPHY

Facility

$5,100.00

Service Code	HCPCS 74455
Hospital Charge Code	2000784
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
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	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
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 URETHROCYSTOGRAPHY RETROGR

Facility

$5,100.00

Service Code	HCPCS 74450
Hospital Charge Code	2004919
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR URETHROCYSTOGRAPHY RETROGR

Facility

$5,100.00

Service Code	HCPCS 74450
Hospital Charge Code	2004919
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
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	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$568.20
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 UROGRAPHY ANTEGRADE PYELO

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	2002335
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
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	$231.09
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UROGRAPHY ANTEGRADE PYELO

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	2002335
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRAPHY-ANTEGRAD RAD SUP

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	5600011
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
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	$231.09
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UROGRAPHY-ANTEGRAD RAD SUP

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	5600011
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRAPHY-ANTEGRAD RAD SUP

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	7411679
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRAPHY-ANTEGRAD RAD SUP

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	7411679
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
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	$231.09
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UROGRAPHY W/NEPHROTOMOGRPHY

Facility

$906.25

Service Code	HCPCS 74415
Hospital Charge Code	2011414
Hospital Revenue Code	320
Min. Negotiated Rate	$117.81
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.09
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UROGRAPHY W/NEPHROTOMOGRPHY

Facility

$906.25

Service Code	HCPCS 74415
Hospital Charge Code	2011414
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRPHY W/INFSN W/O TMGRPY

Facility

$906.25

Service Code	HCPCS 74410
Hospital Charge Code	2011413
Hospital Revenue Code	320
Min. Negotiated Rate	$95.58
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.09
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR UROGRPHY W/INFSN W/O TMGRPY

Facility

$906.25

Service Code	HCPCS 74410
Hospital Charge Code	2011413
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR US GUIDE TISSUE ABLATION

Facility

$1,521.25

Service Code	HCPCS 76940
Hospital Charge Code	5600180
Hospital Revenue Code	361
Min. Negotiated Rate	$228.19
Max. Negotiated Rate	$228.19
Rate for Payer: Qualcare PPO/HMO/WC	$228.19

XR US GUIDE TISSUE ABLATION

Facility

$1,521.25

Service Code	HCPCS 76940
Hospital Charge Code	5600180
Hospital Revenue Code	361
Min. Negotiated Rate	$197.76
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$456.38
Rate for Payer: Aetna Medicare Advantage	$456.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.92
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	$387.92
Rate for Payer: Cigna Commercial	$760.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.76
Rate for Payer: Qualcare PPO/HMO/WC	$228.19

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	7411439
Hospital Revenue Code	361
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

Know your out-of-pocket cost for care.

All Charges