Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR VENOUS MECH THROMBECTOMY

Facility

$25,423.30

Service Code	HCPCS 37187
Hospital Charge Code	411037187
Hospital Revenue Code	361
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

XR VENOUS MECH THROMBECTOMY

Facility

$25,423.30

Service Code	HCPCS 37187
Hospital Charge Code	366837187
Hospital Revenue Code	361
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

XR VENOUS MECH THROMBECTOMY

Facility

$25,423.30

Service Code	HCPCS 37187
Hospital Charge Code	366837187
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$27,491.26
Rate for Payer: Aetna Commercial	$7,626.99
Rate for Payer: Aetna Medicare Advantage	$7,626.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,482.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,482.94
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	$6,482.94
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,305.03
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR VENOUS MECH THROMBECTOMY

Facility

$27,397.00

Service Code	HCPCS 37187
Hospital Charge Code	5600143
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

XR VENOUS M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37188
Hospital Charge Code	7411497
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR VENOUS M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37188
Hospital Charge Code	7411497
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VENOUS M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37188
Hospital Charge Code	5600144
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VENOUS M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37188
Hospital Charge Code	5600144
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$5,492.34
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.01
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

XR VIDEORADIOGRPHY/CINERADGRPY

Facility

$471.30

Service Code	HCPCS 76120
Hospital Charge Code	2011421
Hospital Revenue Code	320
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

XR VIDEORADIOGRPHY/CINERADGRPY

Facility

$471.30

Service Code	HCPCS 76120
Hospital Charge Code	2011421
Hospital Revenue Code	320
Min. Negotiated Rate	$61.27
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: Aetna Medicare Advantage	$141.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.18
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.27
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR WRIST 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7310050
Hospital Charge Code	2011422
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR WRIST 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7310050
Hospital Charge Code	2011422
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 WRIST COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7311050
Hospital Charge Code	2011423
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR WRIST COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7311050
Hospital Charge Code	2011423
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
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

XR WRIST LT

Facility

$6,601.19

Service Code	HCPCS 73110LT
Hospital Charge Code	2000065
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR WRIST LT

Facility

$6,601.19

Service Code	HCPCS 73110LT
Hospital Charge Code	2000065
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 WRIST LT 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2002426
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR WRIST LT 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2002426
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 WRIST RT

Facility

$6,601.19

Service Code	HCPCS 73110RT
Hospital Charge Code	2000066
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 WRIST RT

Facility

$6,601.19

Service Code	HCPCS 73110RT
Hospital Charge Code	2000066
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR WRIST RT 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73100RT
Hospital Charge Code	2002427
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 WRIST RT 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73100RT
Hospital Charge Code	2002427
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR XERORADIOGPHY NON MAMMGRPHY

Facility

$258.70

Service Code	HCPCS 76150
Hospital Charge Code	2011424
Hospital Revenue Code	320
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$1,489.00
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) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
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

XR XERORADIOGPHY NON MAMMGRPHY

Facility

$258.70

Service Code	HCPCS 76150
Hospital Charge Code	2011424
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR ZYGOMATIC ARCHES MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	2000529
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