Heights University Hospital

All Charges

Charge

Type

Setting

Price

RIMXR ELBOW RT COMPL***

Facility

$88.00

Service Code	HCPCS 73080RT
Hospital Charge Code	2011069
Hospital Revenue Code	320
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RIMXR FEMUR LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73550LT
Hospital Charge Code	2011047
Hospital Revenue Code	320
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR FEMUR LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73550LT
Hospital Charge Code	2011047
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR FEMUR RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73550LT
Hospital Charge Code	2011048
Hospital Revenue Code	320
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR FEMUR RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73550LT
Hospital Charge Code	2011048
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR FOOT LT COMPL 3VWS

Facility

$101.00

Service Code	HCPCS 73630LT
Hospital Charge Code	2011054
Hospital Revenue Code	320
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR FOOT LT COMPL 3VWS

Facility

$101.00

Service Code	HCPCS 73630LT
Hospital Charge Code	2011054
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR FOOT RT COMPL 3VWS

Facility

$101.00

Service Code	HCPCS 73630RT
Hospital Charge Code	2011055
Hospital Revenue Code	320
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR FOOT RT COMPL 3VWS

Facility

$101.00

Service Code	HCPCS 73630RT
Hospital Charge Code	2011055
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR HAND LT COMPLETE

Facility

$88.00

Service Code	HCPCS 7313RT
Hospital Charge Code	2011062
Hospital Revenue Code	320
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RIMXR HAND LT COMPLETE

Facility

$88.00

Service Code	HCPCS 7313RT
Hospital Charge Code	2011062
Hospital Revenue Code	320
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$26.40
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR HAND RT COMPLETE

Facility

$88.00

Service Code	HCPCS 73130RT
Hospital Charge Code	2011063
Hospital Revenue Code	320
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$26.40
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR HAND RT COMPLETE

Facility

$88.00

Service Code	HCPCS 73130RT
Hospital Charge Code	2011063
Hospital Revenue Code	320
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RIMXR HIP LT COMPL 2VW

Facility

$124.00

Service Code	HCPCS 73510LT
Hospital Charge Code	2010080
Hospital Revenue Code	320
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR HIP LT COMPL 2VW

Facility

$124.00

Service Code	HCPCS 73510LT
Hospital Charge Code	2010080
Hospital Revenue Code	320
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

RIMXR HIP RT COMPL 2VW

Facility

$124.00

Service Code	HCPCS 73510RT
Hospital Charge Code	2010081
Hospital Revenue Code	320
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$37.20
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR HIP RT COMPL 2VW

Facility

$124.00

Service Code	HCPCS 73510RT
Hospital Charge Code	2010081
Hospital Revenue Code	320
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

RIMXR HUMERUS RT

Facility

$329.00

Service Code	HCPCS 73606RT
Hospital Charge Code	2011022
Hospital Revenue Code	320
Min. Negotiated Rate	$42.77
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$98.70
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR HUMERUS RT

Facility

$329.00

Service Code	HCPCS 73606RT
Hospital Charge Code	2011022
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

RIMXR KNEE LT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 735060LT
Hospital Charge Code	2010098
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

RIMXR KNEE LT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 735060LT
Hospital Charge Code	2010098
Hospital Revenue Code	320
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR KNEE RT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 73560RT
Hospital Charge Code	2010099
Hospital Revenue Code	320
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$49.50
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR KNEE RT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 73560RT
Hospital Charge Code	2010099
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

RIMXR L-S SPINE 2 VIEWS

Facility

$101.00

Service Code	HCPCS 72100
Hospital Charge Code	2010056
Hospital Revenue Code	320
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

RIMXR L-S SPINE 2 VIEWS

Facility

$101.00

Service Code	HCPCS 72100
Hospital Charge Code	2010056
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

Know your out-of-pocket cost for care.

All Charges