Heights University Hospital

All Charges

Charge

Type

Setting

Price

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$6,601.19

Service Code	HCPCS 73521
Hospital Charge Code	2011560
Hospital Revenue Code	320
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$1,980.36
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) NJ Health	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$248.96
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

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73521
Hospital Charge Code	94061480
Hospital Revenue Code	320
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$1,530.00
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) NJ Health	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$248.96
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

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73521
Hospital Charge Code	94061480
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

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	$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

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	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$6,601.19

Service Code	HCPCS 73521
Hospital Charge Code	2011560
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

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	$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

HIP SELF CENTERING 45 GRY 28

Facility

$3,125.00

Hospital Charge Code	270657413
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIP SELF CENTERING 45 GRY 28

Facility

$3,125.00

Hospital Charge Code	270657413
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIP SELF CENTERING 47 BRN 38

Facility

$3,125.00

Hospital Charge Code	270657415
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIP SELF CENTERING 47 BRN 38

Facility

$3,125.00

Hospital Charge Code	270657415
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIPS INFANT/CHILD-BIL

Facility

$204.00

Hospital Charge Code	2009330
Hospital Revenue Code	322
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

HIPS INFANT/CHILD-BIL

Facility

$204.00

Hospital Charge Code	2009330
Hospital Revenue Code	322
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

HIP SPICA

Facility

$785.65

Hospital Charge Code	4000048
Hospital Revenue Code	270
Min. Negotiated Rate	$102.13
Max. Negotiated Rate	$392.82
Rate for Payer: Aetna Commercial	$235.69
Rate for Payer: Aetna Medicare Advantage	$235.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.34
Rate for Payer: Cigna Commercial	$392.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.13
Rate for Payer: Oxford Commercial	$392.82
Rate for Payer: Qualcare PPO/HMO/WC	$117.85
Rate for Payer: UnitedHealthcare Commercial	$392.82

HIP SPICA

Facility

$785.65

Hospital Charge Code	4000048
Hospital Revenue Code	270
Min. Negotiated Rate	$117.85
Max. Negotiated Rate	$117.85
Rate for Payer: Qualcare PPO/HMO/WC	$117.85

HIP SPICA WITH PELVIC BAND

Facility

$3,046.45

Service Code	HCPCS L1686
Hospital Charge Code	270610655
Hospital Revenue Code	274
Min. Negotiated Rate	$456.97
Max. Negotiated Rate	$1,397.63
Rate for Payer: Aetna Commercial	$913.93
Rate for Payer: Aetna Medicare Advantage	$913.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$776.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$776.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$609.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$776.84
Rate for Payer: Cigna Commercial	$1,397.63
Rate for Payer: Cigna Medicare Advantage	$838.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.24
Rate for Payer: Qualcare PPO/HMO/WC	$456.97

HIP SPICA WITH PELVIC BAND

Facility

$3,046.45

Service Code	HCPCS L1686
Hospital Charge Code	270610655
Hospital Revenue Code	274
Min. Negotiated Rate	$456.97
Max. Negotiated Rate	$737.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$609.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.24
Rate for Payer: Qualcare PPO/HMO/WC	$456.97

HIP STEM CEMENTED

Facility

$2,743.60

Hospital Charge Code	270660304
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$1,371.80
Rate for Payer: Aetna Commercial	$823.08
Rate for Payer: Aetna Medicare Advantage	$823.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.62
Rate for Payer: Cigna Commercial	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HIP STEM CEMENTED

Facility

$2,743.60

Hospital Charge Code	270660304
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$663.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HIP STEM C-TPR 127DEG 35x160MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672946
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.50
Max. Negotiated Rate	$3,593.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50

HIP STEM C-TPR 127DEG 35x160MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672946
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.50
Max. Negotiated Rate	$7,425.00
Rate for Payer: Aetna Commercial	$4,455.00
Rate for Payer: Aetna Medicare Advantage	$4,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,786.75
Rate for Payer: Cigna Commercial	$7,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50

HIP STEM-LEFT HIP

Facility

$30,917.25

Service Code	HCPCS C1776
Hospital Charge Code	270677234
Hospital Revenue Code	278
Min. Negotiated Rate	$4,637.59
Max. Negotiated Rate	$7,481.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,183.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,481.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,637.59

HIP STEM-LEFT HIP

Facility

$30,917.25

Service Code	HCPCS C1776
Hospital Charge Code	270677234
Hospital Revenue Code	278
Min. Negotiated Rate	$4,637.59
Max. Negotiated Rate	$15,458.62
Rate for Payer: Aetna Commercial	$9,275.17
Rate for Payer: Aetna Medicare Advantage	$9,275.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,883.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,883.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,183.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,883.90
Rate for Payer: Cigna Commercial	$15,458.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,481.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,637.59

HIP STEM NECK ANGLE SZ 0

Facility

$17,491.50

Hospital Charge Code	270676688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.72
Max. Negotiated Rate	$4,232.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,498.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,232.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,623.72

HIP STEM NECK ANGLE SZ 0

Facility

$17,491.50

Hospital Charge Code	270676688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.72
Max. Negotiated Rate	$8,745.75
Rate for Payer: Aetna Commercial	$5,247.45
Rate for Payer: Aetna Medicare Advantage	$5,247.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,460.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,460.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,498.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,460.33
Rate for Payer: Cigna Commercial	$8,745.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,232.94
Rate for Payer: Qualcare PPO/HMO/WC	$2,623.72

Know your out-of-pocket cost for care.

All Charges