Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLN DX PAT-KNEE 1 OR 2 VW-LT

Facility

$306.00

Service Code	HCPCS 73560LT
Hospital Charge Code	75190505
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-KNEE 1 OR 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	75190510
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLN DX PAT-KNEE 1 OR 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	75190510
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

CLN DX PAT-KNEE 3VWS-BIL

Facility

$250.00

Service Code	HCPCS 7356250
Hospital Charge Code	75190335
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-KNEE 3VWS-BIL

Facility

$250.00

Service Code	HCPCS 7356250
Hospital Charge Code	75190335
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-KNEE MIN 3VIEWS-LT

Facility

$332.00

Service Code	HCPCS 73562LT
Hospital Charge Code	75190515
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-KNEE MIN 3VIEWS-LT

Facility

$332.00

Service Code	HCPCS 73562LT
Hospital Charge Code	75190515
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-KNEE MIN 3VIEWS-RT

Facility

$332.00

Service Code	HCPCS 73562RT
Hospital Charge Code	75190520
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-KNEE MIN 3VIEWS-RT

Facility

$332.00

Service Code	HCPCS 73562RT
Hospital Charge Code	75190520
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-LOW LEG/TIB/FIB-BI

Facility

$250.00

Service Code	HCPCS 7359050
Hospital Charge Code	75190340
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-LOW LEG/TIB/FIB-BI

Facility

$250.00

Service Code	HCPCS 7359050
Hospital Charge Code	75190340
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-LOW LEG/TIB/FIB-LT

Facility

$306.00

Service Code	HCPCS 73590LT
Hospital Charge Code	75190525
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-LOW LEG/TIB/FIB-LT

Facility

$306.00

Service Code	HCPCS 73590LT
Hospital Charge Code	75190525
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-LOW LEG/TIB/FIB-RT

Facility

$307.00

Service Code	HCPCS 73590RT
Hospital Charge Code	75190530
Hospital Revenue Code	320
Min. Negotiated Rate	$46.05
Max. Negotiated Rate	$46.05
Rate for Payer: Qualcare PPO/HMO/WC	$46.05

CLN DX PAT-LOW LEG/TIB/FIB-RT

Facility

$307.00

Service Code	HCPCS 73590RT
Hospital Charge Code	75190530
Hospital Revenue Code	320
Min. Negotiated Rate	$39.91
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$92.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.28
Rate for Payer: Cigna Commercial	$153.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.91
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.05
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

CLN DX PAT-L/S SPINE

Facility

$765.00

Service Code	HCPCS 72110
Hospital Charge Code	75190270
Hospital Revenue Code	320
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

CLN DX PAT-L/S SPINE

Facility

$765.00

Service Code	HCPCS 72110
Hospital Charge Code	75190270
Hospital Revenue Code	320
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

CLN DX PAT-SHOULDER 1 VIEW-LT

Facility

$250.00

Service Code	HCPCS 73020LT
Hospital Charge Code	75190375
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-SHOULDER 1 VIEW-LT

Facility

$250.00

Service Code	HCPCS 73020LT
Hospital Charge Code	75190375
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-SHOULDER 1 VIEW-RT

Facility

$250.00

Service Code	HCPCS 73020RT
Hospital Charge Code	75190380
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-SHOULDER 1 VIEW-RT

Facility

$250.00

Service Code	HCPCS 73020RT
Hospital Charge Code	75190380
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-SHOULDER 1 VW-BIL

Facility

$250.00

Service Code	HCPCS 7302050
Hospital Charge Code	75190295
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-SHOULDER 1 VW-BIL

Facility

$250.00

Service Code	HCPCS 7302050
Hospital Charge Code	75190295
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-SHOULDER 2 VWS-BIL

Facility

$250.00

Service Code	HCPCS 7303050
Hospital Charge Code	75190300
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-SHOULDER 2 VWS-BIL

Facility

$250.00

Service Code	HCPCS 7303050
Hospital Charge Code	75190300
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges