Heights University Hospital

All Charges

Charge

Type

Setting

Price

FORCEP VEC TTS PYLOR 10 4810

Facility

$973.65

Hospital Charge Code	270603928
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 15 4815

Facility

$973.65

Hospital Charge Code	270603930
Hospital Revenue Code	270
Min. Negotiated Rate	$126.57
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$292.10
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.57
Rate for Payer: Oxford Commercial	$486.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Commercial	$486.82

FORCEP VEC TTS PYLOR 15 4815

Facility

$973.65

Hospital Charge Code	270603930
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 18 4818

Facility

$973.65

Hospital Charge Code	270603931
Hospital Revenue Code	270
Min. Negotiated Rate	$126.57
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$292.10
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.57
Rate for Payer: Oxford Commercial	$486.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Commercial	$486.82

FORCEP VEC TTS PYLOR 18 4818

Facility

$973.65

Hospital Charge Code	270603931
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 6 4806

Facility

$973.65

Hospital Charge Code	270603926
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FORCEP VEC TTS PYLOR 6 4806

Facility

$973.65

Hospital Charge Code	270603926
Hospital Revenue Code	270
Min. Negotiated Rate	$126.57
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$292.10
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.57
Rate for Payer: Oxford Commercial	$486.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Commercial	$486.82

FORCEP VEC TTS PYLOR 8 4808

Facility

$973.65

Hospital Charge Code	270603927
Hospital Revenue Code	270
Min. Negotiated Rate	$126.57
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$292.10
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.57
Rate for Payer: Oxford Commercial	$486.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Commercial	$486.82

FORCEP VEC TTS PYLOR 8 4808

Facility

$973.65

Hospital Charge Code	270603927
Hospital Revenue Code	270
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$146.05
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

FOREARM AP & LAT-BILAT

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	94061223
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-BILAT

Facility

$6,601.19

Service Code	HCPCS 7309050
Hospital Charge Code	94061223
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FOREARM AP & LAT-LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	94061305
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FOREARM AP & LAT-LT

Facility

$6,601.19

Service Code	HCPCS 73090LT
Hospital Charge Code	94061305
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	94061307
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FOREARM AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73090RT
Hospital Charge Code	94061307
Hospital Revenue Code	320
Min. Negotiated Rate	$858.15
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$1,980.36
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FORECEP BPSY RADIAL EDGE 1.8MM

Facility

$1,600.00

Hospital Charge Code	270656986
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

FORECEP BPSY RADIAL EDGE 1.8MM

Facility

$1,600.00

Hospital Charge Code	270656986
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$480.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

FOREIGNBODY 1 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061151
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

FOREIGNBODY 1 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061151
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FOREIGNBODY 2 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061153
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

FOREIGNBODY 2 VW-CHILD

Facility

$250.00

Service Code	HCPCS 76010
Hospital Charge Code	94061153
Hospital Revenue Code	320
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

FOREIGN BODY RETRIEVAL

Facility

$315.33

Service Code	HCPCS 37197
Hospital Charge Code	2200402
Hospital Revenue Code	350
Min. Negotiated Rate	$40.99
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$94.60
Rate for Payer: Aetna Medicare Advantage	$94.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,316.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.41
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.99
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.30
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

FOREIGN BODY RETRIEVAL

Facility

$315.33

Service Code	HCPCS 37197
Hospital Charge Code	2200402
Hospital Revenue Code	350
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$47.30

FORESKIN MANIPULATION

Facility

$1,247.64

Service Code	HCPCS 54450
Hospital Charge Code	16001001
Hospital Revenue Code	360
Min. Negotiated Rate	$162.19
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$374.29
Rate for Payer: Aetna Medicare Advantage	$374.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.15
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	$318.15
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.19
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.15
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

FORESKIN MANIPULATION

Facility

$1,247.64

Service Code	HCPCS 54450
Hospital Charge Code	16001001
Hospital Revenue Code	360
Min. Negotiated Rate	$187.15
Max. Negotiated Rate	$187.15
Rate for Payer: Qualcare PPO/HMO/WC	$187.15

Know your out-of-pocket cost for care.

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