Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$111,009.21

Service Code	MSDRG 037
Min. Negotiated Rate	$34,002.99
Max. Negotiated Rate	$111,009.21
Rate for Payer: Aetna Commercial	$111,009.21
Rate for Payer: Aetna Medicare Advantage	$35,925.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93,176.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93,176.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35,792.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93,176.46
Rate for Payer: Cigna Medicare Advantage	$35,792.62
Rate for Payer: Clover Medicare Advantage	$34,002.99
Rate for Payer: EmblemHealth Commercial	$107,377.86
Rate for Payer: Humana Medicare Advantage	$36,866.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$35,792.62
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37,940.18
Rate for Payer: Wellcare Medicare Advantage	$35,792.62

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$45,941.97

Service Code	MSDRG 039
Min. Negotiated Rate	$12,827.74
Max. Negotiated Rate	$45,941.97
Rate for Payer: Aetna Commercial	$39,637.72
Rate for Payer: Aetna Medicare Advantage	$12,827.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,426.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,426.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,313.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,426.38
Rate for Payer: Cigna Medicare Advantage	$15,313.99
Rate for Payer: Clover Medicare Advantage	$14,548.29
Rate for Payer: EmblemHealth Commercial	$45,941.97
Rate for Payer: Humana Medicare Advantage	$15,773.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,313.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,232.83
Rate for Payer: Wellcare Medicare Advantage	$15,313.99

EXTRACTABLE NUC ANTIGENS

Facility

$476.00

Service Code	HCPCS 86235
Hospital Charge Code	38476051
Hospital Revenue Code	302
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.09
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.70
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: Cigna Medicare Advantage	$8.96
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.01
Rate for Payer: Wellcare Medicare Advantage	$17.93

EXTRACTABLE NUC ANTIGENS

Facility

$476.00

Service Code	HCPCS 86235
Hospital Charge Code	38476051
Hospital Revenue Code	302
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

EXTRACTION ERUPTED TOOTH EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000777
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTION ERUPTED TOOTH EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000777
Hospital Revenue Code	360
Min. Negotiated Rate	$1,272.71
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,937.01
Rate for Payer: Aetna Medicare Advantage	$2,937.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,496.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,496.46
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	$2,496.46
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTION ERUPTED TOOTH/EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000743
Hospital Revenue Code	360
Min. Negotiated Rate	$1,272.71
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,937.01
Rate for Payer: Aetna Medicare Advantage	$2,937.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,496.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,496.46
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	$2,496.46
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTION ERUPTED TOOTH/EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000743
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTOR BROKEN SCREW 7MM

Facility

$1,550.00

Hospital Charge Code	270694536
Hospital Revenue Code	272
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$465.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$775.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$775.00

EXTRACTOR BROKEN SCREW 7MM

Facility

$1,550.00

Hospital Charge Code	270694536
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

EXTRACTOR CK STNE FLT 4W 3F***

Facility

$444.00

Hospital Charge Code	1604628
Hospital Revenue Code	272
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

EXTRACTOR CK STNE FLT 4W 3F***

Facility

$444.00

Hospital Charge Code	1604628
Hospital Revenue Code	272
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$133.20
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.72
Rate for Payer: Oxford Commercial	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$222.00

EXTRACTOR CK STONE HEL 3WR****

Facility

$389.00

Hospital Charge Code	1604644
Hospital Revenue Code	272
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.57
Rate for Payer: Oxford Commercial	$194.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$194.50

EXTRACTOR CK STONE HEL 3WR****

Facility

$444.00

Hospital Charge Code	1604669
Hospital Revenue Code	272
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

EXTRACTOR CK STONE HEL 3WR****

Facility

$444.00

Hospital Charge Code	1604669
Hospital Revenue Code	272
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$133.20
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.72
Rate for Payer: Oxford Commercial	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$222.00

EXTRACTOR CK STONE HEL 3WR****

Facility

$389.00

Hospital Charge Code	1604644
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

EXTRACTOR CK STONE HEL 4WR****

Facility

$369.00

Hospital Charge Code	1604677
Hospital Revenue Code	272
Min. Negotiated Rate	$47.97
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$110.70
Rate for Payer: Aetna Medicare Advantage	$110.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.09
Rate for Payer: Cigna Commercial	$184.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.97
Rate for Payer: Oxford Commercial	$184.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.35
Rate for Payer: UnitedHealthcare Commercial	$184.50

EXTRACTOR CK STONE HEL 4WR****

Facility

$369.00

Hospital Charge Code	1604677
Hospital Revenue Code	272
Min. Negotiated Rate	$55.35
Max. Negotiated Rate	$55.35
Rate for Payer: Qualcare PPO/HMO/WC	$55.35

EXTRACTOR CK STONE HEL 5WR****

Facility

$389.00

Hospital Charge Code	1604651
Hospital Revenue Code	272
Min. Negotiated Rate	$50.57
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.57
Rate for Payer: Oxford Commercial	$194.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$194.50

EXTRACTOR CK STONE HEL 5WR****

Facility

$389.00

Hospital Charge Code	1604651
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

EXTRACTOR CK STONE HEL RTR 7F*

Facility

$778.00

Hospital Charge Code	1604636
Hospital Revenue Code	272
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$389.00
Rate for Payer: Aetna Commercial	$233.40
Rate for Payer: Aetna Medicare Advantage	$233.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.39
Rate for Payer: Cigna Commercial	$389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.14
Rate for Payer: Oxford Commercial	$389.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.70
Rate for Payer: UnitedHealthcare Commercial	$389.00

EXTRACTOR CK STONE HEL RTR 7F*

Facility

$778.00

Hospital Charge Code	1604636
Hospital Revenue Code	272
Min. Negotiated Rate	$116.70
Max. Negotiated Rate	$116.70
Rate for Payer: Qualcare PPO/HMO/WC	$116.70

EXTRACTOR CONICAL LARGE

Facility

$1,750.00

Hospital Charge Code	270688297
Hospital Revenue Code	272
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$875.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$875.00

EXTRACTOR CONICAL LARGE

Facility

$1,750.00

Hospital Charge Code	270688297
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

EXTRACTOR MCV TRPL LMN 5047-05

Facility

$936.85

Hospital Charge Code	270616279
Hospital Revenue Code	272
Min. Negotiated Rate	$121.79
Max. Negotiated Rate	$468.43
Rate for Payer: Aetna Commercial	$281.06
Rate for Payer: Aetna Medicare Advantage	$281.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.90
Rate for Payer: Cigna Commercial	$468.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.79
Rate for Payer: Oxford Commercial	$468.43
Rate for Payer: Qualcare PPO/HMO/WC	$140.53
Rate for Payer: UnitedHealthcare Commercial	$468.43

Know your out-of-pocket cost for care.

All Charges