Heights University Hospital

All Charges

Charge

Type

Setting

Price

DBM PUTTY TREL-XPRESS 300C

Facility

$14,811.25

Service Code	HCPCS C9359
Hospital Charge Code	270657169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,221.69
Max. Negotiated Rate	$7,405.62
Rate for Payer: Aetna Commercial	$4,443.38
Rate for Payer: Aetna Medicare Advantage	$4,443.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,776.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,776.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,962.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,776.87
Rate for Payer: Cigna Commercial	$7,405.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,584.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,221.69

DBM PUTTY TREL-XPRESS 300C

Facility

$14,811.25

Service Code	HCPCS C9359
Hospital Charge Code	270657169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,221.69
Max. Negotiated Rate	$3,584.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,962.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,584.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,221.69

DBM SPONGE BLOCK 10 X10 X 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

DBM SPONGE BLOCK 10 X10 X 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

DBM SPONGE STRIP 35X20X7 MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DBM SPONGE STRIP 35X20X7 MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DBM SPONGE STRIPS 35X20X7MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692560
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DBM SPONGE STRIPS 35X20X7MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692560
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$3,375.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DBRDMT SKIN ABDOMINAL WALL

Facility

$9,712.00

Service Code	HCPCS 11005
Hospital Charge Code	1600000809
Hospital Revenue Code	360
Min. Negotiated Rate	$1,456.80
Max. Negotiated Rate	$1,456.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.80

DBRDMT SKIN ABDOMINAL WALL

Facility

$9,712.00

Service Code	HCPCS 11005
Hospital Charge Code	1600000809
Hospital Revenue Code	360
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$6,873.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.80
Rate for Payer: Aetna Commercial	$2,913.60
Rate for Payer: Aetna Medicare Advantage	$2,913.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.56
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	$2,476.56
Rate for Payer: Cigna Commercial	$748.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,262.56
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

DBRDMT SUBQ TISS EACH ADDL

Facility

$2,452.00

Service Code	HCPCS 11045
Hospital Charge Code	1600000756
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$367.80
Rate for Payer: Qualcare PPO/HMO/WC	$367.80

DBRDMT SUBQ TISS EACH ADDL

Facility

$2,452.00

Service Code	HCPCS 11045
Hospital Charge Code	1600000756
Hospital Revenue Code	360
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$735.60
Rate for Payer: Aetna Medicare Advantage	$735.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$625.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$625.26
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	$625.26
Rate for Payer: Cigna Commercial	$23.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.76
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.80
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

DBRD SK,SQ TISS,MUSCLE,BONE OP

Facility

$13,927.00

Service Code	HCPCS 11012
Hospital Charge Code	5770050
Hospital Revenue Code	450
Min. Negotiated Rate	$431.05
Max. Negotiated Rate	$7,775.06
Rate for Payer: Aetna Better Health Medicaid	$7,622.61
Rate for Payer: Aetna Commercial	$4,178.10
Rate for Payer: Aetna Medicare Advantage	$4,178.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,551.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,551.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$431.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,551.39
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,810.51
Rate for Payer: Qualcare PPO/HMO/WC	$2,089.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,775.06

DBRD SK,SQ TISS,MUSCLE,BONE OP

Facility

$13,927.00

Service Code	HCPCS 11012
Hospital Charge Code	5770050
Hospital Revenue Code	450
Min. Negotiated Rate	$2,089.05
Max. Negotiated Rate	$2,089.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,089.05

DBRID SKIN @ ADDNL 20 SQ CM

Facility

$623.14

Service Code	HCPCS 97597
Hospital Charge Code	75190160
Hospital Revenue Code	761
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

DBRID SKIN @ ADDNL 20 SQ CM

Facility

$623.14

Service Code	HCPCS 97597
Hospital Charge Code	75190160
Hospital Revenue Code	761
Min. Negotiated Rate	$81.01
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$186.94
Rate for Payer: Aetna Medicare Advantage	$186.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.90
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.01
Rate for Payer: Oxford Commercial	$311.57
Rate for Payer: Qualcare PPO/HMO/WC	$93.47
Rate for Payer: UnitedHealthcare Commercial	$311.57

DBX CONNECTIVE TISSUE,H 0.5 CC

Facility

$263.00

Hospital Charge Code	27038005
Hospital Revenue Code	278
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$131.50
Rate for Payer: Aetna Commercial	$78.90
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.65
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

DBX CONNECTIVE TISSUE,H 0.5 CC

Facility

$263.00

Hospital Charge Code	27038005
Hospital Revenue Code	278
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.65
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

DBX MIX 5CC

Facility

$5,231.10

Hospital Charge Code	270673044
Hospital Revenue Code	278
Min. Negotiated Rate	$784.66
Max. Negotiated Rate	$1,265.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,265.93
Rate for Payer: Qualcare PPO/HMO/WC	$784.66

DBX MIX 5CC

Facility

$5,231.10

Hospital Charge Code	270673044
Hospital Revenue Code	278
Min. Negotiated Rate	$784.66
Max. Negotiated Rate	$2,615.55
Rate for Payer: Aetna Commercial	$1,569.33
Rate for Payer: Aetna Medicare Advantage	$1,569.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,333.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,333.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,333.93
Rate for Payer: Cigna Commercial	$2,615.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,265.93
Rate for Payer: Qualcare PPO/HMO/WC	$784.66

DBX PUTTY CONNECT TISS 1 CC

Facility

$468.00

Hospital Charge Code	27038010
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

DBX PUTTY CONNECT TISS 1 CC

Facility

$468.00

Hospital Charge Code	27038010
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$140.40
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$71,298.87

Service Code	MSDRG 744
Min. Negotiated Rate	$22,360.97
Max. Negotiated Rate	$71,298.87
Rate for Payer: Aetna Commercial	$69,095.40
Rate for Payer: Aetna Medicare Advantage	$22,360.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,825.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,825.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,766.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,825.96
Rate for Payer: Cigna Commercial	$44,098.68
Rate for Payer: Cigna Medicare Advantage	$23,766.29
Rate for Payer: Clover Medicare Advantage	$22,577.98
Rate for Payer: EmblemHealth Commercial	$71,298.87
Rate for Payer: Humana Medicare Advantage	$24,479.28
Rate for Payer: Oxford Commercial	$27,560.40
Rate for Payer: UnitedHealthcare Commercial	$31,283.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,766.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,192.27
Rate for Payer: Wellcare Medicare Advantage	$23,766.29

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$44,838.99

Service Code	MSDRG 745
Min. Negotiated Rate	$12,413.06
Max. Negotiated Rate	$44,838.99
Rate for Payer: Aetna Commercial	$38,356.36
Rate for Payer: Aetna Medicare Advantage	$12,413.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,669.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,669.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,946.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,669.68
Rate for Payer: Cigna Commercial	$24,480.14
Rate for Payer: Cigna Medicare Advantage	$14,946.33
Rate for Payer: Clover Medicare Advantage	$14,199.01
Rate for Payer: EmblemHealth Commercial	$44,838.99
Rate for Payer: Humana Medicare Advantage	$15,394.72
Rate for Payer: Oxford Commercial	$15,299.38
Rate for Payer: UnitedHealthcare Commercial	$17,366.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,946.33
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,843.11
Rate for Payer: Wellcare Medicare Advantage	$14,946.33

D&C DIAG OR THERAP NOT OB

Facility

$16,333.80

Service Code	HCPCS 58120
Hospital Charge Code	16000760
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$4,900.14
Rate for Payer: Aetna Medicare Advantage	$4,900.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,165.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,165.12
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	$4,165.12
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,123.39
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

Know your out-of-pocket cost for care.

All Charges