Heights University Hospital

All Charges

Charge

Type

Setting

Price

XR KNEE COMPLETE RIGHT

Facility

$5,100.00

Service Code	HCPCS 73564RT
Hospital Charge Code	2011356
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR KNEE COMPLETE RIGHT

Facility

$5,100.00

Service Code	HCPCS 73564RT
Hospital Charge Code	2011356
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 KNEE LT

Facility

$6,601.19

Service Code	HCPCS 73560LT
Hospital Charge Code	2000180
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR KNEE LT

Facility

$6,601.19

Service Code	HCPCS 73560LT
Hospital Charge Code	2000180
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 KNEE RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	2000181
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR KNEE RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	2000181
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 LAPARO CHOLECYSTECTOMY/GRAP

Facility

$10,038.25

Service Code	HCPCS 47563
Hospital Charge Code	2011215
Hospital Revenue Code	361
Min. Negotiated Rate	$1,505.74
Max. Negotiated Rate	$1,505.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,505.74

XR LAPARO CHOLECYSTECTOMY/GRAP

Facility

$10,038.25

Service Code	HCPCS 47563
Hospital Charge Code	2011215
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.97
Max. Negotiated Rate	$14,396.79
Rate for Payer: Aetna Commercial	$3,011.47
Rate for Payer: Aetna Medicare Advantage	$3,011.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,559.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,559.75
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	$2,559.75
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.97
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,505.74
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

XR LAPAROSCOPY W/CHOLANGIO

Facility

$7,404.75

Service Code	HCPCS 47560
Hospital Charge Code	2011200
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.71
Max. Negotiated Rate	$1,110.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.71

XR LAPAROSCOPY W/CHOLANGIO

Facility

$7,404.75

Service Code	HCPCS 47560
Hospital Charge Code	2011200
Hospital Revenue Code	361
Min. Negotiated Rate	$962.62
Max. Negotiated Rate	$3,702.38
Rate for Payer: Aetna Commercial	$2,221.43
Rate for Payer: Aetna Medicare Advantage	$2,221.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,888.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,888.21
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	$1,888.21
Rate for Payer: Cigna Commercial	$3,702.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$962.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.71

XR LAPARO W/ CHOLANGIO/BIOPSY

Facility

$7,404.75

Hospital Charge Code	2011205
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.71
Max. Negotiated Rate	$1,110.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.71

XR LAPARO W/ CHOLANGIO/BIOPSY

Facility

$7,404.75

Hospital Charge Code	2011205
Hospital Revenue Code	361
Min. Negotiated Rate	$962.62
Max. Negotiated Rate	$3,702.38
Rate for Payer: Aetna Commercial	$2,221.43
Rate for Payer: Aetna Medicare Advantage	$2,221.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,888.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,888.21
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	$1,888.21
Rate for Payer: Cigna Commercial	$3,702.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$962.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.71

XR LAP BAND ADJUSTMENT

Facility

$4,980.00

Service Code	HCPCS 43999
Hospital Charge Code	404143999
Hospital Revenue Code	361
Min. Negotiated Rate	$647.40
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,494.00
Rate for Payer: Aetna Medicare Advantage	$1,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,269.90
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	$1,269.90
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$647.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$747.00
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

XR LAP BAND ADJUSTMENT

Facility

$4,980.00

Service Code	HCPCS 43999
Hospital Charge Code	404143999
Hospital Revenue Code	361
Min. Negotiated Rate	$747.00
Max. Negotiated Rate	$747.00
Rate for Payer: Qualcare PPO/HMO/WC	$747.00

XR LARYNOGRAM

Facility

$258.70

Service Code	HCPCS 70373
Hospital Charge Code	2011357
Hospital Revenue Code	320
Min. Negotiated Rate	$33.63
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$77.61
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.63
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR LARYNOGRAM

Facility

$258.70

Service Code	HCPCS 70373
Hospital Charge Code	2011357
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR LE INFANT BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	2011358
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 LE INFANT BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	2011358
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR LE LT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73592LT
Hospital Charge Code	2002160
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR LE LT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73592LT
Hospital Charge Code	2002160
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 LE RT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	2002161
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR LE RT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	2002161
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 LOOPOGRAM ANTE URO

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	2002053
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR LOOPOGRAM ANTE URO

Facility

$906.25

Service Code	HCPCS 74425
Hospital Charge Code	2002053
Hospital Revenue Code	320
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$271.88
Rate for Payer: Aetna Medicare Advantage	$271.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.09
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.81
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

XR LUMBOSACRAL SPINE W/ OBLIQ

Facility

$5,151.86

Service Code	HCPCS 72110
Hospital Charge Code	2002038
Hospital Revenue Code	320
Min. Negotiated Rate	$772.78
Max. Negotiated Rate	$772.78
Rate for Payer: Qualcare PPO/HMO/WC	$772.78

Know your out-of-pocket cost for care.

All Charges