Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXTREMITY ANGIO-RT

Facility

$6,122.00

Service Code	HCPCS 75710RT
Hospital Charge Code	7412003
Hospital Revenue Code	323
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

EXTREMITY ANGIO-RT

Facility

$15,468.50

Service Code	HCPCS 75710RT
Hospital Charge Code	366875710R
Hospital Revenue Code	323
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

EXTREMITY ANGIO-RT

Facility

$15,468.50

Service Code	HCPCS 75710RT
Hospital Charge Code	2691870
Hospital Revenue Code	323
Min. Negotiated Rate	$1,311.00
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$4,640.55
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

EXTREMITY STUDY

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	421093970
Hospital Revenue Code	921
Min. Negotiated Rate	$518.65
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$518.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

EXTREMITY STUDY

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	421093971
Hospital Revenue Code	921
Min. Negotiated Rate	$248.96
Max. Negotiated Rate	$5,160.00
Rate for Payer: Aetna Commercial	$5,160.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,236.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$5,061.00

EXTREMITY STUDY

Facility

$17,200.00

Service Code	HCPCS 93971
Hospital Charge Code	421093971
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

EXTREMITY STUDY

Facility

$17,200.00

Service Code	HCPCS 93970
Hospital Charge Code	421093970
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

EXT STEM MAXIM 14x80 141614

Facility

$5,366.75

Hospital Charge Code	270635587
Hospital Revenue Code	272
Min. Negotiated Rate	$697.68
Max. Negotiated Rate	$2,683.38
Rate for Payer: Aetna Commercial	$1,610.03
Rate for Payer: Aetna Medicare Advantage	$1,610.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,368.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,368.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,368.52
Rate for Payer: Cigna Commercial	$2,683.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.68
Rate for Payer: Oxford Commercial	$2,683.38
Rate for Payer: Qualcare PPO/HMO/WC	$805.01
Rate for Payer: UnitedHealthcare Commercial	$2,683.38

EXT STEM MAXIM 14x80 141614

Facility

$5,366.75

Hospital Charge Code	270635587
Hospital Revenue Code	272
Min. Negotiated Rate	$805.01
Max. Negotiated Rate	$805.01
Rate for Payer: Qualcare PPO/HMO/WC	$805.01

EXT TABS/TOWER

Facility

$1,125.00

Hospital Charge Code	270704175
Hospital Revenue Code	279
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

EXT TABS/TOWER

Facility

$1,125.00

Hospital Charge Code	270704175
Hospital Revenue Code	279
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.25
Rate for Payer: Oxford Commercial	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$562.50

EYE BOX****

Facility

$153.00

Hospital Charge Code	8002255
Hospital Revenue Code	279
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

EYE BOX****

Facility

$153.00

Hospital Charge Code	8002255
Hospital Revenue Code	279
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.89
Rate for Payer: Oxford Commercial	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$76.50

EYE BOX STABISMUS*****

Facility

$81.00

Hospital Charge Code	8002263
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

EYE BOX STABISMUS*****

Facility

$81.00

Hospital Charge Code	8002263
Hospital Revenue Code	279
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$40.50

EYE CONFORMER LARGE

Facility

$270.00

Hospital Charge Code	270688505
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

EYE CONFORMER LARGE

Facility

$270.00

Hospital Charge Code	270688505
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

EYE CONFORMER LARGE HOLE

Facility

$315.00

Hospital Charge Code	270688504
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$76.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

EYE CONFORMER LARGE HOLE

Facility

$315.00

Hospital Charge Code	270688504
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare Advantage	$94.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.33
Rate for Payer: Cigna Commercial	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

EYE CONFORMER MEDIUM

Facility

$270.00

Hospital Charge Code	270688503
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

EYE CONFORMER MEDIUM

Facility

$270.00

Hospital Charge Code	270688503
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

EYE CONFORMER MEDIUM HOLE

Facility

$315.00

Hospital Charge Code	270688507
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare Advantage	$94.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.33
Rate for Payer: Cigna Commercial	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

EYE CONFORMER MEDIUM HOLE

Facility

$315.00

Hospital Charge Code	270688507
Hospital Revenue Code	278
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$76.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.25

EYE CONFORMER SMALL

Facility

$270.00

Hospital Charge Code	270688502
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

EYE CONFORMER SMALL

Facility

$270.00

Hospital Charge Code	270688502
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

Know your out-of-pocket cost for care.

All Charges