Heights University Hospital

All Charges

Charge

Type

Setting

Price

RIMXR LT HUMERUS

Facility

$329.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2011021
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 LT HUMERUS

Facility

$329.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2011021
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

RIMXR PELVIS 3 VIEWS

Facility

$101.00

Service Code	HCPCS 72190
Hospital Charge Code	2010064
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	$37.40
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 PELVIS 3 VIEWS

Facility

$101.00

Service Code	HCPCS 72190
Hospital Charge Code	2010064
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR SHOULDER LT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030LT
Hospital Charge Code	2010072
Hospital Revenue Code	320
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$33.90
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR SHOULDER LT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030LT
Hospital Charge Code	2010072
Hospital Revenue Code	320
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

RIMXR SHOULDER RT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030RT
Hospital Charge Code	2010073
Hospital Revenue Code	320
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

RIMXR SHOULDER RT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030RT
Hospital Charge Code	2010073
Hospital Revenue Code	320
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$33.90
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

RIMXR SKULL 4 VIEWS

Facility

$124.00

Service Code	HCPCS 70260
Hospital Charge Code	2010031
Hospital Revenue Code	320
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Better Health Medicaid	$399.88
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) NJ Health	$51.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$248.96
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88

RIMXR SKULL 4 VIEWS

Facility

$124.00

Service Code	HCPCS 70260
Hospital Charge Code	2010031
Hospital Revenue Code	320
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

RIMXR TIBIA/FIBULA LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590LT
Hospital Charge Code	2011039
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR TIBIA/FIBULA LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590LT
Hospital Charge Code	2011039
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 TIBIA/FIBULA RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590RT
Hospital Charge Code	2011040
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR TIBIA/FIBULA RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590RT
Hospital Charge Code	2011040
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 WRIST LT COMPL 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2011013
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 WRIST LT COMPL 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2011013
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR WRIST RT COMPL 2 VIEWS**

Facility

$101.00

Service Code	HCPCS 73110RT
Hospital Charge Code	2011014
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR WRIST RT COMPL 2 VIEWS**

Facility

$101.00

Service Code	HCPCS 73110RT
Hospital Charge Code	2011014
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

RING 1/3 COMPSTE SM 6D FC10028

Facility

$1,190.45

Hospital Charge Code	270632629
Hospital Revenue Code	272
Min. Negotiated Rate	$178.57
Max. Negotiated Rate	$178.57
Rate for Payer: Qualcare PPO/HMO/WC	$178.57

RING 1/3 COMPSTE SM 6D FC10028

Facility

$1,190.45

Hospital Charge Code	270632629
Hospital Revenue Code	272
Min. Negotiated Rate	$154.76
Max. Negotiated Rate	$595.23
Rate for Payer: Aetna Commercial	$357.13
Rate for Payer: Aetna Medicare Advantage	$357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.56
Rate for Payer: Cigna Commercial	$595.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.76
Rate for Payer: Oxford Commercial	$595.23
Rate for Payer: Qualcare PPO/HMO/WC	$178.57
Rate for Payer: UnitedHealthcare Commercial	$595.23

RING 2/3 ALUMM MED 8IN FA10029

Facility

$2,480.00

Hospital Charge Code	270612445
Hospital Revenue Code	272
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

RING 2/3 ALUMM MED 8IN FA10029

Facility

$2,480.00

Hospital Charge Code	270612445
Hospital Revenue Code	272
Min. Negotiated Rate	$322.40
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$744.00
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.40
Rate for Payer: Oxford Commercial	$1,240.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

RING 2/3 COMPSTE SM 6D FC10028

Facility

$2,281.65

Hospital Charge Code	270632630
Hospital Revenue Code	272
Min. Negotiated Rate	$342.25
Max. Negotiated Rate	$342.25
Rate for Payer: Qualcare PPO/HMO/WC	$342.25

RING 2/3 COMPSTE SM 6D FC10028

Facility

$2,281.65

Hospital Charge Code	270632630
Hospital Revenue Code	272
Min. Negotiated Rate	$296.61
Max. Negotiated Rate	$1,140.83
Rate for Payer: Aetna Commercial	$684.50
Rate for Payer: Aetna Medicare Advantage	$684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$581.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$581.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$581.82
Rate for Payer: Cigna Commercial	$1,140.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.61
Rate for Payer: Oxford Commercial	$1,140.83
Rate for Payer: Qualcare PPO/HMO/WC	$342.25
Rate for Payer: UnitedHealthcare Commercial	$1,140.83

RING 3/4 140mm ID 393734

Facility

$1,580.95

Hospital Charge Code	270633840
Hospital Revenue Code	272
Min. Negotiated Rate	$205.52
Max. Negotiated Rate	$790.48
Rate for Payer: Aetna Commercial	$474.29
Rate for Payer: Aetna Medicare Advantage	$474.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.14
Rate for Payer: Cigna Commercial	$790.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.52
Rate for Payer: Oxford Commercial	$790.48
Rate for Payer: Qualcare PPO/HMO/WC	$237.14
Rate for Payer: UnitedHealthcare Commercial	$790.48

Know your out-of-pocket cost for care.

All Charges