Heights University Hospital

All Charges

Charge

Type

Setting

Price

INSERT TIBIA TRIATH SZ4CS16MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697364
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

INSERT TIBILA FLEX R20MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687438
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBILA FLEX R20MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687438
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIB INFINIT POLY 7MM

Facility

$19,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693699
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

INSERT TIB INFINIT POLY 7MM

Facility

$19,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693699
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$5,850.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

INSERT TIB SZ5 LONG INFINITY

Facility

$55,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270693698
Hospital Revenue Code	278
Min. Negotiated Rate	$8,350.50
Max. Negotiated Rate	$13,472.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,472.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,350.50

INSERT TIB SZ5 LONG INFINITY

Facility

$55,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270693698
Hospital Revenue Code	278
Min. Negotiated Rate	$8,350.50
Max. Negotiated Rate	$27,835.00
Rate for Payer: Aetna Commercial	$16,701.00
Rate for Payer: Aetna Medicare Advantage	$16,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,195.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,195.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,195.85
Rate for Payer: Cigna Commercial	$27,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,472.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,350.50

INSERT TISSUE EXPANDER(S)

Facility

$17,020.16

Service Code	HCPCS 11960
Hospital Charge Code	16000782
Hospital Revenue Code	360
Min. Negotiated Rate	$2,553.02
Max. Negotiated Rate	$2,553.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,553.02

INSERT TISSUE EXPANDER(S)

Facility

$17,020.16

Service Code	HCPCS 11960
Hospital Charge Code	16000782
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,439.01
Rate for Payer: Aetna Commercial	$5,106.05
Rate for Payer: Aetna Medicare Advantage	$5,106.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,340.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,340.14
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	$4,340.14
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.62
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,553.02
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

INSERT TOTAL STABILIZER SZ 7

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270691991
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

INSERT TOTAL STABILIZER SZ 7

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270691991
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$7,177.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

INSERT TRIDENT X3 PE 36MM

Facility

$4,155.70

Service Code	HCPCS C1776
Hospital Charge Code	270694558
Hospital Revenue Code	278
Min. Negotiated Rate	$623.36
Max. Negotiated Rate	$1,005.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$831.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.68
Rate for Payer: Qualcare PPO/HMO/WC	$623.36

INSERT TRIDENT X3 PE 36MM

Facility

$4,155.70

Service Code	HCPCS C1776
Hospital Charge Code	270694558
Hospital Revenue Code	278
Min. Negotiated Rate	$623.36
Max. Negotiated Rate	$2,077.85
Rate for Payer: Aetna Commercial	$1,246.71
Rate for Payer: Aetna Medicare Advantage	$1,246.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,059.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,059.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$831.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,059.70
Rate for Payer: Cigna Commercial	$2,077.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.68
Rate for Payer: Qualcare PPO/HMO/WC	$623.36

INSERT TRI-TSA PLUS POLY 19MM

Facility

$13,581.75

Service Code	HCPCS C1776
Hospital Charge Code	270677997
Hospital Revenue Code	278
Min. Negotiated Rate	$2,037.26
Max. Negotiated Rate	$6,790.88
Rate for Payer: Aetna Commercial	$4,074.53
Rate for Payer: Aetna Medicare Advantage	$4,074.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,463.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,463.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,716.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,463.35
Rate for Payer: Cigna Commercial	$6,790.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,037.26

INSERT TRI-TSA PLUS POLY 19MM

Facility

$13,581.75

Service Code	HCPCS C1776
Hospital Charge Code	270677997
Hospital Revenue Code	278
Min. Negotiated Rate	$2,037.26
Max. Negotiated Rate	$3,286.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,716.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,037.26

INSERT TUN CV CATH W/O PORT

Facility

$17,869.95

Service Code	HCPCS 36565
Hospital Charge Code	7411456
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$5,360.98
Rate for Payer: Aetna Medicare Advantage	$5,360.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,556.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,556.84
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	$4,556.84
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,323.09
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.49
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

INSERT TUN CV CATH W/O PORT

Facility

$17,869.95

Service Code	HCPCS 36565
Hospital Charge Code	7411456
Hospital Revenue Code	361
Min. Negotiated Rate	$2,680.49
Max. Negotiated Rate	$2,680.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.49

INSERT URO/VES NCK SPHINCTER

Facility

$94,818.40

Service Code	HCPCS 53445
Hospital Charge Code	1600000493
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$49,357.08
Rate for Payer: Aetna Commercial	$28,445.52
Rate for Payer: Aetna Medicare Advantage	$28,445.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,178.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,178.69
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	$24,178.69
Rate for Payer: Cigna Commercial	$49,357.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,326.39
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.76
Rate for Payer: UnitedHealthcare Commercial	$11,456.00

INSERT URO/VES NCK SPHINCTER

Facility

$94,818.40

Service Code	HCPCS 53445
Hospital Charge Code	1600000493
Hospital Revenue Code	360
Min. Negotiated Rate	$14,222.76
Max. Negotiated Rate	$14,222.76
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.76

INSERT VAD ARTERY ACCESS

Facility

$5,500.00

Service Code	HCPCS 33990
Hospital Charge Code	411033990
Hospital Revenue Code	361
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT VAD ARTERY ACCESS

Facility

$5,500.00

Service Code	HCPCS 33990
Hospital Charge Code	411033990
Hospital Revenue Code	361
Min. Negotiated Rate	$337.02
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
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	$1,402.50
Rate for Payer: Cigna Commercial	$337.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

INSERT X3 THIATHLON CS #3 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692078
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

INSERT X3 THIATHLON CS #3 11MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692078
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,524.70
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

INSERT X3 TRIATHLON CS S 6

Facility

$4,269.20

Service Code	HCPCS C1776
Hospital Charge Code	270692359
Hospital Revenue Code	278
Min. Negotiated Rate	$640.38
Max. Negotiated Rate	$1,033.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$853.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.15
Rate for Payer: Qualcare PPO/HMO/WC	$640.38

INSERT X3 TRIATHLON CS S 6

Facility

$4,269.20

Service Code	HCPCS C1776
Hospital Charge Code	270692359
Hospital Revenue Code	278
Min. Negotiated Rate	$640.38
Max. Negotiated Rate	$2,134.60
Rate for Payer: Aetna Commercial	$1,280.76
Rate for Payer: Aetna Medicare Advantage	$1,280.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,088.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,088.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$853.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,088.65
Rate for Payer: Cigna Commercial	$2,134.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.15
Rate for Payer: Qualcare PPO/HMO/WC	$640.38

Know your out-of-pocket cost for care.

All Charges