Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXCALIBUR CURVED HL 4.2 MMX19C

Facility

$330.00

Hospital Charge Code	270682875
Hospital Revenue Code	272
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$99.00
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Commercial	$165.00

EXCALIBUR HL 4.2MM X19CM

Facility

$385.00

Hospital Charge Code	270687988
Hospital Revenue Code	272
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$57.75
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

EXCALIBUR HL 4.2MM X19CM

Facility

$385.00

Hospital Charge Code	270687988
Hospital Revenue Code	272
Min. Negotiated Rate	$50.05
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$115.50
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.05
Rate for Payer: Oxford Commercial	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Commercial	$192.50

EXC ARM/ELBOW LES SC < 3 CM

Facility

$16,857.75

Service Code	HCPCS 24075
Hospital Charge Code	16000409
Hospital Revenue Code	360
Min. Negotiated Rate	$2,528.66
Max. Negotiated Rate	$2,528.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,528.66

EXC ARM/ELBOW LES SC < 3 CM

Facility

$16,857.75

Service Code	HCPCS 24075
Hospital Charge Code	16000409
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,057.32
Rate for Payer: Aetna Commercial	$5,057.32
Rate for Payer: Aetna Medicare Advantage	$5,057.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,298.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,298.73
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	$4,298.73
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,528.66
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC ARM/ELBOW LES SC 3 CM/>

Facility

$25,274.60

Service Code	HCPCS 24071
Hospital Charge Code	16000310
Hospital Revenue Code	360
Min. Negotiated Rate	$3,791.19
Max. Negotiated Rate	$3,791.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,791.19

EXC ARM/ELBOW LES SC 3 CM/>

Facility

$25,274.60

Service Code	HCPCS 24071
Hospital Charge Code	16000310
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,582.38
Rate for Payer: Aetna Commercial	$7,582.38
Rate for Payer: Aetna Medicare Advantage	$7,582.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,445.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,445.02
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	$6,445.02
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.70
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,791.19
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC BACK LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 21930
Hospital Charge Code	16000315
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC BACK LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 21930
Hospital Charge Code	16000315
Hospital Revenue Code	360
Min. Negotiated Rate	$1,770.02
Max. Negotiated Rate	$4,084.65
Rate for Payer: Aetna Commercial	$4,084.65
Rate for Payer: Aetna Medicare Advantage	$4,084.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.95
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	$3,471.95
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC BACK LES SC 3+ CM

Facility

$22,282.25

Service Code	HCPCS 21931
Hospital Charge Code	16000194
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,684.68
Rate for Payer: Aetna Commercial	$6,684.68
Rate for Payer: Aetna Medicare Advantage	$6,684.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,681.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,681.97
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	$5,681.97
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,896.69
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,342.34
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC BACK LES SC 3+ CM

Facility

$22,282.25

Service Code	HCPCS 21931
Hospital Charge Code	16000194
Hospital Revenue Code	360
Min. Negotiated Rate	$3,342.34
Max. Negotiated Rate	$3,342.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,342.34

EXC BACK TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 21932
Hospital Charge Code	16000497
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC BACK TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 21932
Hospital Charge Code	16000497
Hospital Revenue Code	360
Min. Negotiated Rate	$1,770.02
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$4,084.65
Rate for Payer: Aetna Medicare Advantage	$4,084.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,471.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,471.95
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	$3,471.95
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

EXC BACK TUM DEEP 5 CM/>

Facility

$20,625.50

Service Code	HCPCS 21933
Hospital Charge Code	16000300
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

EXC BACK TUM DEEP 5 CM/>

Facility

$20,625.50

Service Code	HCPCS 21933
Hospital Charge Code	16000300
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$6,187.65
Rate for Payer: Aetna Medicare Advantage	$6,187.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,259.50
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	$5,259.50
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,681.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

EXC BENIGN LES DIAM 0.6-1.0 CM

Facility

$2,080.70

Service Code	HCPCS 11441
Hospital Charge Code	75190080
Hospital Revenue Code	761
Min. Negotiated Rate	$312.11
Max. Negotiated Rate	$312.11
Rate for Payer: Qualcare PPO/HMO/WC	$312.11

EXC BENIGN LES DIAM 0.6-1.0 CM

Facility

$2,080.70

Service Code	HCPCS 11441
Hospital Charge Code	75190080
Hospital Revenue Code	761
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$1,686.34
Rate for Payer: Aetna Commercial	$624.21
Rate for Payer: Aetna Medicare Advantage	$624.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$530.58
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.49
Rate for Payer: Oxford Commercial	$1,040.35
Rate for Payer: Qualcare PPO/HMO/WC	$312.11
Rate for Payer: UnitedHealthcare Commercial	$1,040.35

EXC BENIGN LES DIAM 1.1-2.0 CM

Facility

$3,473.00

Service Code	HCPCS 11422
Hospital Charge Code	75190060
Hospital Revenue Code	761
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

EXC BENIGN LES DIAM 1.1-2.0 CM

Facility

$3,473.00

Service Code	HCPCS 11422
Hospital Charge Code	75190060
Hospital Revenue Code	761
Min. Negotiated Rate	$113.00
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,041.90
Rate for Payer: Aetna Medicare Advantage	$1,041.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.62
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.49
Rate for Payer: Oxford Commercial	$1,736.50
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Commercial	$1,736.50

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$7,392.00

Service Code	HCPCS 11423
Hospital Charge Code	75190065
Hospital Revenue Code	761
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$7,392.00

Service Code	HCPCS 11423
Hospital Charge Code	75190065
Hospital Revenue Code	761
Min. Negotiated Rate	$130.09
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$2,217.60
Rate for Payer: Aetna Medicare Advantage	$2,217.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,884.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,884.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,884.96
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$960.96
Rate for Payer: Oxford Commercial	$3,696.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Commercial	$3,696.00

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$3,472.00

Service Code	HCPCS 11443
Hospital Charge Code	75190090
Hospital Revenue Code	761
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$520.80
Rate for Payer: Qualcare PPO/HMO/WC	$520.80

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$3,472.00

Service Code	HCPCS 11443
Hospital Charge Code	75190090
Hospital Revenue Code	761
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$1,041.60
Rate for Payer: Aetna Medicare Advantage	$1,041.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.36
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.36
Rate for Payer: Oxford Commercial	$1,736.00
Rate for Payer: Qualcare PPO/HMO/WC	$520.80
Rate for Payer: UnitedHealthcare Commercial	$1,736.00

EXC BENIGN LES DIAM 2.1-3.0CM

Facility

$3,439.81

Service Code	HCPCS 11403
Hospital Charge Code	75190045
Hospital Revenue Code	761
Min. Negotiated Rate	$122.85
Max. Negotiated Rate	$1,719.90
Rate for Payer: Aetna Commercial	$1,031.94
Rate for Payer: Aetna Medicare Advantage	$1,031.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$877.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$877.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$877.15
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.18
Rate for Payer: Oxford Commercial	$1,719.90
Rate for Payer: Qualcare PPO/HMO/WC	$515.97
Rate for Payer: UnitedHealthcare Commercial	$1,719.90

EXC BENIGN LES DIAM 2.1-3.0CM

Facility

$3,439.81

Service Code	HCPCS 11403
Hospital Charge Code	75190045
Hospital Revenue Code	761
Min. Negotiated Rate	$515.97
Max. Negotiated Rate	$515.97
Rate for Payer: Qualcare PPO/HMO/WC	$515.97

Know your out-of-pocket cost for care.

All Charges