Heights University Hospital

All Charges

Charge

Type

Setting

Price

CUP BMT BIPOL 53MM 11-165230

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270625411
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CUP BMT BIPOL 53MM 11-165230

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270625411
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CUP BMT BIPOL 58MM 11-165240

Facility

$4,533.50

Hospital Charge Code	270618284
Hospital Revenue Code	278
Min. Negotiated Rate	$680.02
Max. Negotiated Rate	$2,266.75
Rate for Payer: Aetna Commercial	$1,360.05
Rate for Payer: Aetna Medicare Advantage	$1,360.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,156.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,156.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$906.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,156.04
Rate for Payer: Cigna Commercial	$2,266.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,097.11
Rate for Payer: Qualcare PPO/HMO/WC	$680.02

CUP BMT BIPOL 58MM 11-165240

Facility

$4,533.50

Hospital Charge Code	270618284
Hospital Revenue Code	278
Min. Negotiated Rate	$680.02
Max. Negotiated Rate	$1,097.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$906.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,097.11
Rate for Payer: Qualcare PPO/HMO/WC	$680.02

CUP DELTA XTEND HUM PE STD38/6

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270686440
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,440.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

CUP DELTA XTEND HUM PE STD38/6

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270686440
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

CUP DENTURE PLASTIC

Facility

$4.00

Hospital Charge Code	270300746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CUP DENTURE PLASTIC

Facility

$4.00

Hospital Charge Code	270300746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CUP DENTURE W/LID

Facility

$0.58

Hospital Charge Code	270649396
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna Commercial	$0.17
Rate for Payer: Aetna Medicare Advantage	$0.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.15
Rate for Payer: Cigna Commercial	$0.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.08
Rate for Payer: Oxford Commercial	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.09
Rate for Payer: UnitedHealthcare Commercial	$0.29

CUP DENTURE W/LID

Facility

$0.58

Hospital Charge Code	270649396
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.09

CUP FEEDING***

Facility

$68.00

Hospital Charge Code	8000739
Hospital Revenue Code	279
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$34.00
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$34.00

CUP FEEDING***

Facility

$68.00

Hospital Charge Code	8000739
Hospital Revenue Code	279
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

CUP FOAM HOT 6oz

Facility

$3.15

Hospital Charge Code	270649650
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.57
Rate for Payer: Aetna Commercial	$0.95
Rate for Payer: Aetna Medicare Advantage	$0.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.80
Rate for Payer: Cigna Commercial	$1.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.41
Rate for Payer: Oxford Commercial	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$0.47
Rate for Payer: UnitedHealthcare Commercial	$1.57

CUP FOAM HOT 6oz

Facility

$3.15

Hospital Charge Code	270649650
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.47

CUP HUMERAL 36X4MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671576
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CUP HUMERAL 36X4MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671576
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$1,950.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CUP HUMERAL BEAR RET 36MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$3,450.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

CUP HUMERAL BEAR RET 36MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

CUP M2A MAGM PF 62X56 US15862

Facility

$15,376.00

Hospital Charge Code	270634573
Hospital Revenue Code	278
Min. Negotiated Rate	$2,306.40
Max. Negotiated Rate	$3,720.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,075.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,306.40

CUP M2A MAGM PF 62X56 US15862

Facility

$15,376.00

Hospital Charge Code	270634573
Hospital Revenue Code	278
Min. Negotiated Rate	$2,306.40
Max. Negotiated Rate	$7,688.00
Rate for Payer: Aetna Commercial	$4,612.80
Rate for Payer: Aetna Medicare Advantage	$4,612.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,920.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,920.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,075.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,920.88
Rate for Payer: Cigna Commercial	$7,688.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,306.40

CUP M2A MAGNM PF 64x58 US15784

Facility

$16,195.00

Hospital Charge Code	270639184
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$3,919.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

CUP M2A MAGNM PF 64x58 US15784

Facility

$16,195.00

Hospital Charge Code	270639184
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$8,097.50
Rate for Payer: Aetna Commercial	$4,858.50
Rate for Payer: Aetna Medicare Advantage	$4,858.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,129.73
Rate for Payer: Cigna Commercial	$8,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

CUP M2A MAGNUM 50mmODX44mmID

Facility

$18,555.00

Hospital Charge Code	270636874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.25
Max. Negotiated Rate	$4,490.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25

CUP M2A MAGNUM 50mmODX44mmID

Facility

$18,555.00

Hospital Charge Code	270636874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.25
Max. Negotiated Rate	$9,277.50
Rate for Payer: Aetna Commercial	$5,566.50
Rate for Payer: Aetna Medicare Advantage	$5,566.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,731.52
Rate for Payer: Cigna Commercial	$9,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25

CUP M2A MAGNUM 54x48 US157854

Facility

$16,195.00

Hospital Charge Code	270635322
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$8,097.50
Rate for Payer: Aetna Commercial	$4,858.50
Rate for Payer: Aetna Medicare Advantage	$4,858.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,129.73
Rate for Payer: Cigna Commercial	$8,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

Know your out-of-pocket cost for care.

All Charges