Heights University Hospital

All Charges

Charge

Type

Setting

Price

E1 VNGD PS+ TIB BRG 63/67X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682023
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$85.02
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$9.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$103.00

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

EAR CARTILAGE GRAFT

Facility

$34,833.20

Service Code	HCPCS 21235
Hospital Charge Code	1600000717
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,097.46
Rate for Payer: Aetna Commercial	$10,449.96
Rate for Payer: Aetna Medicare Advantage	$10,449.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,882.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,882.47
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	$8,882.47
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,528.32
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,224.98
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EAR CARTILAGE GRAFT

Facility

$34,833.20

Service Code	HCPCS 21235
Hospital Charge Code	1600000717
Hospital Revenue Code	360
Min. Negotiated Rate	$5,224.98
Max. Negotiated Rate	$5,224.98
Rate for Payer: Qualcare PPO/HMO/WC	$5,224.98

EAR DRILL RENTAL

Facility

$867.00

Hospital Charge Code	270338804
Hospital Revenue Code	272
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

EAR DRILL RENTAL

Facility

$867.00

Hospital Charge Code	270338804
Hospital Revenue Code	272
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.71
Rate for Payer: Oxford Commercial	$433.50
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Commercial	$433.50

EAR DRILL RENTAL

Facility

$750.00

Hospital Charge Code	270339437
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

EAR DRILL RENTAL

Facility

$750.00

Hospital Charge Code	270339437
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90785
Hospital Charge Code	84504001
Hospital Revenue Code	900
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$189.42

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90853
Hospital Charge Code	87506096
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$378.84
Rate for Payer: Aetna Commercial	$378.84
Rate for Payer: Aetna Medicare Advantage	$378.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.01
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.16
Rate for Payer: Qualcare PPO/HMO/WC	$189.42
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90785
Hospital Charge Code	84504001
Hospital Revenue Code	900
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$378.84
Rate for Payer: Aetna Medicare Advantage	$378.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.01
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.16
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.42
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90853
Hospital Charge Code	87506096
Hospital Revenue Code	915
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$189.42

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$48,728.46

Service Code	MSDRG 147
Min. Negotiated Rate	$13,875.35
Max. Negotiated Rate	$48,728.46
Rate for Payer: Aetna Commercial	$42,874.83
Rate for Payer: Aetna Medicare Advantage	$13,875.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,183.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,242.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,183.08
Rate for Payer: Cigna Commercial	$27,363.95
Rate for Payer: Cigna Medicare Advantage	$16,242.82
Rate for Payer: Clover Medicare Advantage	$15,430.68
Rate for Payer: EmblemHealth Commercial	$48,728.46
Rate for Payer: Humana Medicare Advantage	$16,730.10
Rate for Payer: Oxford Commercial	$17,101.67
Rate for Payer: UnitedHealthcare Commercial	$19,411.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,242.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17,217.39
Rate for Payer: Wellcare Medicare Advantage	$16,242.82

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$73,281.33

Service Code	MSDRG 146
Min. Negotiated Rate	$23,106.30
Max. Negotiated Rate	$73,281.33
Rate for Payer: Aetna Commercial	$71,398.47
Rate for Payer: Aetna Medicare Advantage	$23,106.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,166.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,427.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,166.37
Rate for Payer: Cigna Commercial	$45,568.57
Rate for Payer: Cigna Medicare Advantage	$24,427.11
Rate for Payer: Clover Medicare Advantage	$23,205.75
Rate for Payer: EmblemHealth Commercial	$73,281.33
Rate for Payer: Humana Medicare Advantage	$25,159.92
Rate for Payer: Oxford Commercial	$28,479.03
Rate for Payer: UnitedHealthcare Commercial	$32,326.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,427.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25,892.74
Rate for Payer: Wellcare Medicare Advantage	$24,427.11

Know your out-of-pocket cost for care.

All Charges