Heights University Hospital

All Charges

Charge

Type

Setting

Price

K-LYTE DS ORANGE/50MEQ/TA

Facility

$5.00

Hospital Charge Code	60633230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

K-LYTE DS ORANGE/50MEQ/TA

Facility

$5.00

Hospital Charge Code	60633230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

K-LYTE ORANGE/25MEQ/TAB

Facility

$5.00

Hospital Charge Code	60633231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

K-LYTE ORANGE/25MEQ/TAB

Facility

$5.00

Hospital Charge Code	60633231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

KNEE 1 OR 2 VIEWS-BILA

Facility

$6,601.19

Service Code	HCPCS 7356050
Hospital Charge Code	94061237
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE 1 OR 2 VIEWS-BILA

Facility

$6,601.19

Service Code	HCPCS 7356050
Hospital Charge Code	94061237
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

KNEE 1 OR 2 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73560LT
Hospital Charge Code	94061365
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

KNEE 1 OR 2 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73560LT
Hospital Charge Code	94061365
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE 1 OR 2 VIEWS-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	94061367
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE 1 OR 2 VIEWS-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	94061367
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

KNEE 4 OR MORE VIEWS-R

Facility

$5,100.00

Service Code	HCPCS 73564RT
Hospital Charge Code	94061375
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

KNEE 4 OR MORE VIEWS-R

Facility

$5,100.00

Service Code	HCPCS 73564RT
Hospital Charge Code	94061375
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

KNEE 4 OR MORE VW-LT

Facility

$5,100.00

Service Code	HCPCS 73564LT
Hospital Charge Code	94061373
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

KNEE 4 OR MORE VW-LT

Facility

$5,100.00

Service Code	HCPCS 73564LT
Hospital Charge Code	94061373
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

KNEE 4 OR MORE VWS-BIL

Facility

$5,100.00

Service Code	HCPCS 7356450
Hospital Charge Code	94061241
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

KNEE 4 OR MORE VWS-BIL

Facility

$5,100.00

Service Code	HCPCS 7356450
Hospital Charge Code	94061241
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

KNEEALIGN 2 NAVIGATION UNIT

Facility

$3,125.00

Hospital Charge Code	270675510
Hospital Revenue Code	272
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

KNEEALIGN 2 NAVIGATION UNIT

Facility

$3,125.00

Hospital Charge Code	270675510
Hospital Revenue Code	272
Min. Negotiated Rate	$406.25
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) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.25
Rate for Payer: Oxford Commercial	$1,562.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Commercial	$1,562.50

KNEEALIGN 2 NAVIGATION UNIT PL

Facility

$2,604.17

Hospital Charge Code	270685463
Hospital Revenue Code	272
Min. Negotiated Rate	$390.63
Max. Negotiated Rate	$390.63
Rate for Payer: Qualcare PPO/HMO/WC	$390.63

KNEEALIGN 2 NAVIGATION UNIT PL

Facility

$2,604.17

Hospital Charge Code	270685463
Hospital Revenue Code	272
Min. Negotiated Rate	$338.54
Max. Negotiated Rate	$1,302.09
Rate for Payer: Aetna Commercial	$781.25
Rate for Payer: Aetna Medicare Advantage	$781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$664.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$664.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$664.06
Rate for Payer: Cigna Commercial	$1,302.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.54
Rate for Payer: Oxford Commercial	$1,302.09
Rate for Payer: Qualcare PPO/HMO/WC	$390.63
Rate for Payer: UnitedHealthcare Commercial	$1,302.09

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$54,619.15

Service Code	APR-DRG 3134
Min. Negotiated Rate	$45,592.83
Max. Negotiated Rate	$54,619.15
Rate for Payer: Aetna Better Health Medicaid	$53,548.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$54,619.15
Rate for Payer: Wellpoint Medicaid Managed Care	$45,592.83

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$18,422.64

Service Code	APR-DRG 3131
Min. Negotiated Rate	$10,695.72
Max. Negotiated Rate	$18,422.64
Rate for Payer: Aetna Better Health Medicaid	$18,061.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,422.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10,695.72

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$34,127.87

Service Code	APR-DRG 3133
Min. Negotiated Rate	$22,407.32
Max. Negotiated Rate	$34,127.87
Rate for Payer: Aetna Better Health Medicaid	$33,458.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,127.87
Rate for Payer: Wellpoint Medicaid Managed Care	$22,407.32

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$23,755.10

Service Code	APR-DRG 3132
Min. Negotiated Rate	$14,639.11
Max. Negotiated Rate	$23,755.10
Rate for Payer: Aetna Better Health Medicaid	$23,289.31
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,755.10
Rate for Payer: Wellpoint Medicaid Managed Care	$14,639.11

KNEE ARTHROSCOP/SURGERY--RT

Facility

$35,454.57

Service Code	HCPCS 29876
Hospital Charge Code	16000179
Hospital Revenue Code	360
Min. Negotiated Rate	$5,318.19
Max. Negotiated Rate	$5,318.19
Rate for Payer: Qualcare PPO/HMO/WC	$5,318.19

Know your out-of-pocket cost for care.

All Charges