Heights University Hospital

All Charges

Charge

Type

Setting

Price

ELECTROSURCICAL PROBE W/HNDL**

Facility

$86.00

Hospital Charge Code	1607027
Hospital Revenue Code	272
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$25.80
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.93
Rate for Payer: Cigna Commercial	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.18
Rate for Payer: Oxford Commercial	$43.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$43.00

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	1008165
Hospital Revenue Code	430
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	1008170
Hospital Revenue Code	420
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	1008165
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	1008170
Hospital Revenue Code	420
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$26.78
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$61.80
Rate for Payer: Aetna Medicare Advantage	$61.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

ELECT VAP 24FR X 5MM 27050RG/6

Facility

$595.25

Hospital Charge Code	270618274
Hospital Revenue Code	272
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$89.29
Rate for Payer: Qualcare PPO/HMO/WC	$89.29

ELECT VAP 24FR X 5MM 27050RG/6

Facility

$595.25

Hospital Charge Code	270618274
Hospital Revenue Code	272
Min. Negotiated Rate	$77.38
Max. Negotiated Rate	$297.62
Rate for Payer: Aetna Commercial	$178.57
Rate for Payer: Aetna Medicare Advantage	$178.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.79
Rate for Payer: Cigna Commercial	$297.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.38
Rate for Payer: Oxford Commercial	$297.62
Rate for Payer: Qualcare PPO/HMO/WC	$89.29
Rate for Payer: UnitedHealthcare Commercial	$297.62

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.00
Max. Negotiated Rate	$6,310.00
Rate for Payer: Aetna Commercial	$3,786.00
Rate for Payer: Aetna Medicare Advantage	$3,786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,218.10
Rate for Payer: Cigna Commercial	$6,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.00
Max. Negotiated Rate	$3,054.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00

Elevate Apical and posterior

Facility

$11,895.00

Hospital Charge Code	270666115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,784.25
Max. Negotiated Rate	$2,878.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,379.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,878.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,784.25

Elevate Apical and posterior

Facility

$11,895.00

Hospital Charge Code	270666115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,784.25
Max. Negotiated Rate	$5,947.50
Rate for Payer: Aetna Commercial	$3,568.50
Rate for Payer: Aetna Medicare Advantage	$3,568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,033.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,033.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,379.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,033.22
Rate for Payer: Cigna Commercial	$5,947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,878.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,784.25

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$99.62
Max. Negotiated Rate	$383.15
Rate for Payer: Aetna Commercial	$229.89
Rate for Payer: Aetna Medicare Advantage	$229.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.41
Rate for Payer: Cigna Commercial	$383.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.62
Rate for Payer: Oxford Commercial	$383.15
Rate for Payer: Qualcare PPO/HMO/WC	$114.94
Rate for Payer: UnitedHealthcare Commercial	$383.15

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$114.94

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$267.90
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.09
Rate for Payer: Oxford Commercial	$446.50
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$446.50

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$267.90
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.09
Rate for Payer: Oxford Commercial	$446.50
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$446.50

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$544.74
Max. Negotiated Rate	$1,089.48
Rate for Payer: Aetna Commercial	$1,089.48
Rate for Payer: Aetna Medicare Advantage	$1,089.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$926.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$926.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$926.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$544.74
Max. Negotiated Rate	$878.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,942.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$2,407.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

ELITE COMPRESS IMPLANT 18X18X1

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ELITE COMPRESS IMPLANT 18X18X1

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

Know your out-of-pocket cost for care.

All Charges