Heights University Hospital

All Charges

Charge

Type

Setting

Price

HIP I VIEW W/WO PELVIS 1V RT

Facility

$358.23

Service Code	HCPCS 73501RT
Hospital Charge Code	94270266
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP I VIEW W/WO PELVIS 1V RT

Facility

$358.23

Service Code	HCPCS 73501RT
Hospital Charge Code	94270266
Hospital Revenue Code	320
Min. Negotiated Rate	$46.57
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$107.47
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	94061486
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

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	2011551
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

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	94061486
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	2011551
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP MAP 3105.001.000

Facility

$2,060.00

Hospital Charge Code	270698390
Hospital Revenue Code	270
Min. Negotiated Rate	$267.80
Max. Negotiated Rate	$1,030.00
Rate for Payer: Aetna Commercial	$618.00
Rate for Payer: Aetna Medicare Advantage	$618.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$525.30
Rate for Payer: Cigna Commercial	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.80
Rate for Payer: Oxford Commercial	$1,030.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00
Rate for Payer: UnitedHealthcare Commercial	$1,030.00

HIP MAP 3105.001.000

Facility

$2,060.00

Hospital Charge Code	270698390
Hospital Revenue Code	270
Min. Negotiated Rate	$309.00
Max. Negotiated Rate	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00

HIP ONE VIEW-LT

Facility

$250.00

Hospital Charge Code	94061353
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP ONE VIEW-LT

Facility

$250.00

Hospital Charge Code	94061353
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

HIP ONE VIEW-RT

Facility

$250.00

Hospital Charge Code	94061355
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP ONE VIEW-RT

Facility

$250.00

Hospital Charge Code	94061355
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

HIP PUSHLOCK 2.9MM

Facility

$1,475.00

Hospital Charge Code	270681575
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

HIP PUSHLOCK 2.9MM

Facility

$1,475.00

Hospital Charge Code	270681575
Hospital Revenue Code	272
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$96,782.82

Service Code	MSDRG 521
Min. Negotiated Rate	$30,125.10
Max. Negotiated Rate	$96,782.82
Rate for Payer: Aetna Commercial	$96,782.82
Rate for Payer: Aetna Medicare Advantage	$31,321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82,425.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82,425.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,710.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82,425.33
Rate for Payer: Cigna Commercial	$61,769.57
Rate for Payer: Cigna Medicare Advantage	$31,710.63
Rate for Payer: Clover Medicare Advantage	$30,125.10
Rate for Payer: EmblemHealth Commercial	$95,131.89
Rate for Payer: Humana Medicare Advantage	$32,661.95
Rate for Payer: Oxford Commercial	$38,604.19
Rate for Payer: UnitedHealthcare Commercial	$43,819.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,710.63
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$33,613.27
Rate for Payer: Wellcare Medicare Advantage	$31,710.63

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$73,290.03

Service Code	MSDRG 522
Min. Negotiated Rate	$23,109.58
Max. Negotiated Rate	$73,290.03
Rate for Payer: Aetna Commercial	$71,408.60
Rate for Payer: Aetna Medicare Advantage	$23,109.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,430.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,166.37
Rate for Payer: Cigna Commercial	$45,575.02
Rate for Payer: Cigna Medicare Advantage	$24,430.01
Rate for Payer: Clover Medicare Advantage	$23,208.51
Rate for Payer: EmblemHealth Commercial	$73,290.03
Rate for Payer: Humana Medicare Advantage	$25,162.91
Rate for Payer: Oxford Commercial	$28,483.06
Rate for Payer: UnitedHealthcare Commercial	$32,330.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,430.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,895.81
Rate for Payer: Wellcare Medicare Advantage	$24,430.01

HIP RETRACTOR SINGLR PRONG

Facility

$2,941.85

Hospital Charge Code	270678487
Hospital Revenue Code	272
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$441.28
Rate for Payer: Qualcare PPO/HMO/WC	$441.28

HIP RETRACTOR SINGLR PRONG

Facility

$2,941.85

Hospital Charge Code	270678487
Hospital Revenue Code	272
Min. Negotiated Rate	$382.44
Max. Negotiated Rate	$1,470.92
Rate for Payer: Aetna Commercial	$882.55
Rate for Payer: Aetna Medicare Advantage	$882.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.17
Rate for Payer: Cigna Commercial	$1,470.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.44
Rate for Payer: Oxford Commercial	$1,470.92
Rate for Payer: Qualcare PPO/HMO/WC	$441.28
Rate for Payer: UnitedHealthcare Commercial	$1,470.92

HIPS BILATERAL WITH PELVIS

Facility

$250.00

Hospital Charge Code	2002665
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIPS BILATERAL WITH PELVIS

Facility

$250.00

Hospital Charge Code	2002665
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

HIPS BILAT W/AP PELVIS

Facility

$250.00

Hospital Charge Code	94061113
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

HIPS BILAT W/AP PELVIS

Facility

$250.00

Hospital Charge Code	94061113
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	94270260
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	2011596
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	75190635
Hospital Revenue Code	320
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$177.98
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges