Heights University Hospital

All Charges

Charge

Type

Setting

Price

DELTA V-40 CERAMIC HEAD 36/+2.

Facility

$14,330.00

Service Code	HCPCS C1776
Hospital Charge Code	270684554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.50
Max. Negotiated Rate	$3,467.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,467.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,149.50

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$2,970.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$2,094.75
Max. Negotiated Rate	$3,379.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$2,094.75
Max. Negotiated Rate	$6,982.50
Rate for Payer: Aetna Commercial	$4,189.50
Rate for Payer: Aetna Medicare Advantage	$4,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,561.07
Rate for Payer: Cigna Commercial	$6,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$151.47
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$70.25
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$5,280.35
Rate for Payer: Aetna Medicare Advantage	$5,280.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,488.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,488.29
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	$4,488.29
Rate for Payer: Cigna Commercial	$70.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,288.15
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$2,640.17
Max. Negotiated Rate	$2,640.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17

DEL US-GUIDE- AMNIOCENTESIS

Facility

$420.00

Service Code	HCPCS 76946
Hospital Charge Code	73190081
Hospital Revenue Code	402
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

DEL US-GUIDE- AMNIOCENTESIS

Facility

$420.00

Service Code	HCPCS 76946
Hospital Charge Code	73190081
Hospital Revenue Code	402
Min. Negotiated Rate	$38.23
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$38.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

DEL US-NUCHAL TRANSLUCEN-1ST

Facility

$423.00

Service Code	HCPCS 76813
Hospital Charge Code	73190065
Hospital Revenue Code	402
Min. Negotiated Rate	$63.45
Max. Negotiated Rate	$63.45
Rate for Payer: Qualcare PPO/HMO/WC	$63.45

DEL US-NUCHAL TRANSLUCEN-1ST

Facility

$423.00

Service Code	HCPCS 76813
Hospital Charge Code	73190065
Hospital Revenue Code	402
Min. Negotiated Rate	$54.99
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$126.90
Rate for Payer: Aetna Medicare Advantage	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.86
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.99
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.45
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$2,010.00
Rate for Payer: Aetna Commercial	$2,010.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$83.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$459.91
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$3,030.00
Rate for Payer: Aetna Medicare Advantage	$3,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,575.50
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,313.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$2,979.00

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.47

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$11.57
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Aetna Medicare Advantage	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.90
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.01
Rate for Payer: Oxford Commercial	$11.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.47
Rate for Payer: UnitedHealthcare Commercial	$11.57

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$6.11
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$10.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$10.19

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

DEMADEX 20 MG U/D TAB

Facility

$2.00

Hospital Charge Code	60635308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

DEMADEX 20 MG U/D TAB

Facility

$2.00

Hospital Charge Code	60635308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

DEMADEX 5MG TAB

Facility

$2.00

Hospital Charge Code	60635385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

DEMADEX 5MG TAB

Facility

$2.00

Hospital Charge Code	60635385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

Know your out-of-pocket cost for care.

All Charges