Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR ANGIOPLASTY ILIAC ARTERY***

Facility

$1,815.00

Service Code	HCPCS 75962
Hospital Charge Code	2002368
Hospital Revenue Code	329
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

XR ANGIOPLASTY RENAL ARTERY***

Facility

$1,932.00

Service Code	HCPCS 75966
Hospital Charge Code	2002384
Hospital Revenue Code	329
Min. Negotiated Rate	$251.16
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$579.60
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ANGIOPLASTY RENAL ARTERY***

Facility

$1,932.00

Service Code	HCPCS 75966
Hospital Charge Code	2002384
Hospital Revenue Code	329
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$289.80
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
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

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANKLE COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7361050
Hospital Charge Code	2011308
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7361050
Hospital Charge Code	2011308
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

XR ANKLE LT

Facility

$6,601.19

Service Code	HCPCS 73610LT
Hospital Charge Code	2000156
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE LT

Facility

$6,601.19

Service Code	HCPCS 73610LT
Hospital Charge Code	2000156
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

XR ANKLE LT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600LT
Hospital Charge Code	2002442
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

XR ANKLE LT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600LT
Hospital Charge Code	2002442
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANKLE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	2000157
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

XR ANKLE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	2000157
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE RT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600RT
Hospital Charge Code	2002443
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

XR ANKLE RT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600RT
Hospital Charge Code	2002443
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANTHROGRAM ANKLE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7361550
Hospital Charge Code	2011447
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ANTHROGRAM ANKLE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7361550
Hospital Charge Code	2011447
Hospital Revenue Code	322
Min. Negotiated Rate	$321.98
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$743.04
Rate for Payer: Aetna Medicare Advantage	$743.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.58
Rate for Payer: Cigna Commercial	$1,238.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.52
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ANTHROGRAM ELBOW BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7308550
Hospital Charge Code	2011437
Hospital Revenue Code	322
Min. Negotiated Rate	$321.98
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$743.04
Rate for Payer: Aetna Medicare Advantage	$743.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.58
Rate for Payer: Cigna Commercial	$1,238.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.52
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ANTHROGRAM ELBOW BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7308550
Hospital Charge Code	2011437
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ANTHROGRAM HIP BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7352550
Hospital Charge Code	2011438
Hospital Revenue Code	322
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$756.00
Rate for Payer: Aetna Medicare Advantage	$756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$642.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$642.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$642.60
Rate for Payer: Cigna Commercial	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ANTHROGRAM HIP BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7352550
Hospital Charge Code	2011438
Hospital Revenue Code	322
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00

XR ANTHROGRAM KNEE

Facility

$1,238.40

Service Code	HCPCS 73580
Hospital Charge Code	2011439
Hospital Revenue Code	322
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$1,627.00
Rate for Payer: Aetna Better Health Medicaid	$1,595.10
Rate for Payer: Aetna Commercial	$371.52
Rate for Payer: Aetna Medicare Advantage	$371.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.79
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.99
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00

XR ANTHROGRAM KNEE

Facility

$1,238.40

Service Code	HCPCS 73580
Hospital Charge Code	2011439
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ANTHROGRAM KNEE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7358050
Hospital Charge Code	2011440
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ANTHROGRAM KNEE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7358050
Hospital Charge Code	2011440
Hospital Revenue Code	322
Min. Negotiated Rate	$321.98
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$743.04
Rate for Payer: Aetna Medicare Advantage	$743.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.58
Rate for Payer: Cigna Commercial	$1,238.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.52
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

Know your out-of-pocket cost for care.

All Charges