Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLN DX PAT-ANKLE COMPLETE-BIL

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	75190355
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ANKLE COMPLETE-BIL

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	75190355
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ANKLE COMPLETE-LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	75190555
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CLN DX PAT-ANKLE COMPLETE-LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	75190555
Hospital Revenue Code	320
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ANKLE COMPLETE-RT

Facility

$332.00

Service Code	HCPCS 73610RT
Hospital Charge Code	75190560
Hospital Revenue Code	320
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ANKLE COMPLETE-RT

Facility

$332.00

Service Code	HCPCS 73610RT
Hospital Charge Code	75190560
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CLN DX PAT-CERVICAL SPINE COM

Facility

$752.00

Service Code	HCPCS 72052
Hospital Charge Code	75190260
Hospital Revenue Code	320
Min. Negotiated Rate	$59.02
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$309.88
Rate for Payer: Aetna Commercial	$225.60
Rate for Payer: Aetna Medicare Advantage	$225.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.76
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.76
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08

CLN DX PAT-CERVICAL SPINE COM

Facility

$752.00

Service Code	HCPCS 72052
Hospital Charge Code	75190260
Hospital Revenue Code	320
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$112.80

CLN DX PAT-CHEST SINGLE VIEW

Facility

$582.98

Service Code	HCPCS 71010
Hospital Charge Code	75190250
Hospital Revenue Code	324
Min. Negotiated Rate	$75.79
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$1,212.34
Rate for Payer: Aetna Commercial	$174.89
Rate for Payer: Aetna Medicare Advantage	$174.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.66
Rate for Payer: Cigna Commercial	$291.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.79
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59

CLN DX PAT-CHEST SINGLE VIEW

Facility

$582.98

Service Code	HCPCS 71010
Hospital Charge Code	75190250
Hospital Revenue Code	324
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

CLN DX PAT-CHEST TWO VIEWS

Facility

$610.00

Service Code	HCPCS 71020
Hospital Charge Code	75190255
Hospital Revenue Code	324
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

CLN DX PAT-CHEST TWO VIEWS

Facility

$610.00

Service Code	HCPCS 71020
Hospital Charge Code	75190255
Hospital Revenue Code	324
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$1,212.34
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59

CLN DX PAT-DORSAL SPIN AP&LA

Facility

$523.00

Service Code	HCPCS 72070
Hospital Charge Code	75190265
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

CLN DX PAT-DORSAL SPIN AP&LA

Facility

$523.00

Service Code	HCPCS 72070
Hospital Charge Code	75190265
Hospital Revenue Code	320
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$156.90
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.37
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

CLN DX PAT-ELBOW 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7308050
Hospital Charge Code	75190305
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-ELBOW 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7308050
Hospital Charge Code	75190305
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ELBOW 3 VIEWS-LT

Facility

$306.00

Service Code	HCPCS 73080LT
Hospital Charge Code	75190395
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

CLN DX PAT-ELBOW 3 VIEWS-LT

Facility

$306.00

Service Code	HCPCS 73080LT
Hospital Charge Code	75190395
Hospital Revenue Code	320
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ELBOW 3 VIEWS-RT

Facility

$250.00

Service Code	HCPCS 73080RT
Hospital Charge Code	75190400
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-ELBOW 3 VIEWS-RT

Facility

$250.00

Service Code	HCPCS 73080RT
Hospital Charge Code	75190400
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-FEMUR AP & LAT-BIL

Facility

$250.00

Hospital Charge Code	75190325
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-FEMUR AP & LAT-BIL

Facility

$250.00

Hospital Charge Code	75190325
Hospital Revenue Code	320
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-FEMUR AP & LAT-LT

Facility

$332.00

Hospital Charge Code	75190495
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CLN DX PAT-FEMUR AP & LAT-LT

Facility

$332.00

Hospital Charge Code	75190495
Hospital Revenue Code	320
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-FEMUR AP & LAT-RT

Facility

$332.00

Hospital Charge Code	75190500
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

Know your out-of-pocket cost for care.

All Charges