Heights University Hospital

All Charges

Charge

Type

Setting

Price

EVANS WEDGE 10MM

Facility

$5,980.00

Hospital Charge Code	270674211
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$1,447.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

EVANS WEDGE 10MM

Facility

$5,980.00

Hospital Charge Code	270674211
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$1,794.00
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

EVANS WEDGE 8MM

Facility

$5,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270674213
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$1,447.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

EVANS WEDGE 8MM

Facility

$5,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270674213
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$1,794.00
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

EVAN WEDGE 8MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270702706
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

EVAN WEDGE 8MM

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270702706
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

EVASC PRLNG ADMN RX AGNT 1ST

Facility

$61,616.39

Service Code	HCPCS 61650
Hospital Charge Code	366861650
Hospital Revenue Code	361
Min. Negotiated Rate	$565.74
Max. Negotiated Rate	$18,484.92
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$565.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC PRLNG ADMN RX AGNT 1ST

Facility

$61,616.39

Service Code	HCPCS 61650
Hospital Charge Code	366861650
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

EVASC PRLNG ADMN RX AGNT 1ST

Facility

$61,616.39

Service Code	HCPCS 61650
Hospital Charge Code	411061650
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

EVASC PRLNG ADMN RX AGNT 1ST

Facility

$61,616.39

Service Code	HCPCS 61650
Hospital Charge Code	411061650
Hospital Revenue Code	361
Min. Negotiated Rate	$565.74
Max. Negotiated Rate	$18,484.92
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$565.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC PRLNG ADMN RX AGNT ADD

Facility

$61,616.39

Service Code	HCPCS 61651
Hospital Charge Code	411061651
Hospital Revenue Code	361
Min. Negotiated Rate	$241.97
Max. Negotiated Rate	$18,484.92
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$241.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC PRLNG ADMN RX AGNT ADD

Facility

$61,616.39

Service Code	HCPCS 61651
Hospital Charge Code	366861651
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

EVASC PRLNG ADMN RX AGNT ADD

Facility

$61,616.39

Service Code	HCPCS 61651
Hospital Charge Code	366861651
Hospital Revenue Code	361
Min. Negotiated Rate	$241.97
Max. Negotiated Rate	$18,484.92
Rate for Payer: Aetna Commercial	$18,484.92
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$241.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,010.13
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC PRLNG ADMN RX AGNT ADD

Facility

$61,616.39

Service Code	HCPCS 61651
Hospital Charge Code	411061651
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

EVASC REPAIR A-ILIAC NDGFT

Facility

$2,450.00

Service Code	HCPCS 34717
Hospital Charge Code	404634717
Hospital Revenue Code	361
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
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	$624.75
Rate for Payer: Cigna Commercial	$425.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC REPAIR A-ILIAC NDGFT

Facility

$2,450.00

Service Code	HCPCS 34717
Hospital Charge Code	404634717
Hospital Revenue Code	361
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	2004951
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	321034701
Hospital Revenue Code	361
Min. Negotiated Rate	$1,201.80
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$1,201.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	411034701
Hospital Revenue Code	360
Min. Negotiated Rate	$1,201.80
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$1,201.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	321034701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	411034701
Hospital Revenue Code	360
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

EVASC RPR A-AO NDGFT

Facility

$13,570.00

Service Code	HCPCS 34701
Hospital Charge Code	2004951
Hospital Revenue Code	361
Min. Negotiated Rate	$1,201.80
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$1,201.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC RPR A-AO NDGFT RPT

Facility

$13,570.00

Service Code	HCPCS 34702
Hospital Charge Code	321034702
Hospital Revenue Code	361
Min. Negotiated Rate	$1,746.70
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$1,746.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC RPR A-AO NDGFT RPT

Facility

$13,570.00

Service Code	HCPCS 34702
Hospital Charge Code	2004952
Hospital Revenue Code	361
Min. Negotiated Rate	$1,746.70
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$1,746.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

EVASC RPR A-AO NDGFT RPT

Facility

$13,570.00

Service Code	HCPCS 34702
Hospital Charge Code	2004952
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

Know your out-of-pocket cost for care.

All Charges