Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR ARTHROGRAM SHOULDER BILTERL

Facility

$2,520.00

Service Code	HCPCS 7304050
Hospital Charge Code	2011442
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 ARTHROGRAM SHOULDER LT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002269
Hospital Revenue Code	322
Min. Negotiated Rate	$39.27
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	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$830.80
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 ARTHROGRAM SHOULDER LT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002269
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAM SHOULDER RT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002270
Hospital Revenue Code	322
Min. Negotiated Rate	$39.27
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	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$830.80
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 ARTHROGRAM SHOULDER RT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002270
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAM TMJ BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7033250
Hospital Charge Code	2011443
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ARTHROGRAM TMJ BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7033250
Hospital Charge Code	2011443
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 ARTHROGRAM TMJ LEFT

Facility

$1,238.40

Service Code	HCPCS 70332LT
Hospital Charge Code	2011444
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM TMJ LEFT

Facility

$1,238.40

Service Code	HCPCS 70332LT
Hospital Charge Code	2011444
Hospital Revenue Code	322
Min. Negotiated Rate	$160.99
Max. Negotiated Rate	$1,489.00
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) PPO	$315.79
Rate for Payer: Cigna Commercial	$619.20
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

XR ARTHROGRAM TMJ RIGHT

Facility

$1,238.40

Service Code	HCPCS 70332RT
Hospital Charge Code	2011445
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM TMJ RIGHT

Facility

$1,238.40

Service Code	HCPCS 70332RT
Hospital Charge Code	2011445
Hospital Revenue Code	322
Min. Negotiated Rate	$160.99
Max. Negotiated Rate	$1,489.00
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) PPO	$315.79
Rate for Payer: Cigna Commercial	$619.20
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

XR ARTHROGRAM WRIST BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7311550
Hospital Charge Code	2011446
Hospital Revenue Code	322
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00

XR ARTHROGRAM WRIST BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7311550
Hospital Charge Code	2011446
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 ARTHROGRAPHY WRIST LEFT

Facility

$5,100.00

Service Code	HCPCS 73115
Hospital Charge Code	2004942
Hospital Revenue Code	322
Min. Negotiated Rate	$39.27
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	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$830.80
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 ARTHROGRAPHY WRIST LEFT

Facility

$5,100.00

Service Code	HCPCS 73115
Hospital Charge Code	2004942
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAPHY WRIST RIGHT

Facility

$1,260.00

Service Code	HCPCS 73115
Hospital Charge Code	2004940
Hospital Revenue Code	322
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$189.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

XR ARTHROGRAPHY WRIST RIGHT

Facility

$1,260.00

Service Code	HCPCS 73115
Hospital Charge Code	2004940
Hospital Revenue Code	322
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$378.00
Rate for Payer: Aetna Medicare Advantage	$378.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.30
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	$321.30
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR ATHERECTOMY OPEN BRACHIO EA

Facility

$40,991.00

Hospital Charge Code	5600110
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,495.50
Rate for Payer: Aetna Commercial	$12,297.30
Rate for Payer: Aetna Medicare Advantage	$12,297.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.70
Rate for Payer: Cigna Commercial	$20,495.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.83
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.65

XR ATHERECTOMY OPEN BRACHIO EA

Facility

$40,991.00

Hospital Charge Code	5600110
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.65
Max. Negotiated Rate	$6,148.65
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.65

XR ATHERECTOMY PERQ AORTIC

Facility

$40,990.35

Hospital Charge Code	5600113
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$12,297.10
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ AORTIC

Facility

$40,990.35

Hospital Charge Code	5600113
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ BRACHIO EA

Facility

$40,990.35

Hospital Charge Code	5600115
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$12,297.10
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ BRACHIO EA

Facility

$40,990.35

Hospital Charge Code	5600115
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ ILIAC

Facility

$40,990.35

Hospital Charge Code	5600114
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$12,297.10
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ ILIAC

Facility

$40,990.35

Hospital Charge Code	5600114
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

Know your out-of-pocket cost for care.

All Charges