Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTERROG DEVICE EVAL PER VISIT

Facility

$214.68

Service Code	HCPCS 93288
Hospital Charge Code	74116022
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

INTERROG DEVICE EVAL PER VISIT

Facility

$214.68

Service Code	HCPCS 93288
Hospital Charge Code	74117022
Hospital Revenue Code	480
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare Advantage	$64.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.74
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

INTERROG DEVICE EVAL PER VISIT

Facility

$214.68

Service Code	HCPCS 93288
Hospital Charge Code	74115022
Hospital Revenue Code	480
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare Advantage	$64.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.74
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.20
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

INTERROG DEVICE EVAL PER VISIT

Facility

$214.68

Service Code	HCPCS 93288
Hospital Charge Code	74115022
Hospital Revenue Code	480
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$32.20

INTER SCREW12X28 FULL THREAD

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270681480
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$352.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INTER SCREW12X28 FULL THREAD

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270681480
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INTERSPACE FOR KNEE LARGE 74mm

Facility

$21,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270680018
Hospital Revenue Code	278
Min. Negotiated Rate	$3,206.25
Max. Negotiated Rate	$5,172.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,172.75
Rate for Payer: Qualcare PPO/HMO/WC	$3,206.25

INTERSPACE FOR KNEE LARGE 74mm

Facility

$21,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270680018
Hospital Revenue Code	278
Min. Negotiated Rate	$3,206.25
Max. Negotiated Rate	$10,687.50
Rate for Payer: Aetna Commercial	$6,412.50
Rate for Payer: Aetna Medicare Advantage	$6,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,450.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,450.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,450.62
Rate for Payer: Cigna Commercial	$10,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,172.75
Rate for Payer: Qualcare PPO/HMO/WC	$3,206.25

INTERSTIM I CON PROGRAMMER

Facility

$9,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270685083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

INTERSTIM I CON PROGRAMMER

Facility

$9,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270685083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$2,925.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

INTERSTIM X SSMRI 97800

Facility

$58,400.00

Service Code	HCPCS L8679
Hospital Charge Code	270695516
Hospital Revenue Code	278
Min. Negotiated Rate	$8,760.00
Max. Negotiated Rate	$14,132.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,132.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,760.00

INTERSTIM X SSMRI 97800

Facility

$58,400.00

Service Code	HCPCS L8679
Hospital Charge Code	270695516
Hospital Revenue Code	278
Min. Negotiated Rate	$6,016.91
Max. Negotiated Rate	$17,520.00
Rate for Payer: Aetna Commercial	$17,520.00
Rate for Payer: Aetna Medicare Advantage	$17,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,892.00
Rate for Payer: Cigna Commercial	$10,028.19
Rate for Payer: Cigna Medicare Advantage	$6,016.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,132.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,760.00

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$9,875.58

Service Code	APR-DRG 1422
Min. Negotiated Rate	$7,536.26
Max. Negotiated Rate	$9,875.58
Rate for Payer: Aetna Better Health Medicaid	$9,681.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,875.58
Rate for Payer: Wellpoint Medicaid Managed Care	$7,536.26

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$8,391.20

Service Code	APR-DRG 1421
Min. Negotiated Rate	$6,196.65
Max. Negotiated Rate	$8,391.20
Rate for Payer: Aetna Better Health Medicaid	$8,226.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,391.20
Rate for Payer: Wellpoint Medicaid Managed Care	$6,196.65

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$24,641.24

Service Code	APR-DRG 1424
Min. Negotiated Rate	$19,298.50
Max. Negotiated Rate	$24,641.24
Rate for Payer: Aetna Better Health Medicaid	$24,158.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,641.24
Rate for Payer: Wellpoint Medicaid Managed Care	$19,298.50

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$14,347.16

Service Code	APR-DRG 1423
Min. Negotiated Rate	$10,904.80
Max. Negotiated Rate	$14,347.16
Rate for Payer: Aetna Better Health Medicaid	$14,065.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,347.16
Rate for Payer: Wellpoint Medicaid Managed Care	$10,904.80

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$39,370.56

Service Code	MSDRG 197
Min. Negotiated Rate	$10,357.13
Max. Negotiated Rate	$39,370.56
Rate for Payer: Aetna Commercial	$32,003.53
Rate for Payer: Aetna Medicare Advantage	$10,357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,123.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,567.00
Rate for Payer: Cigna Commercial	$20,425.58
Rate for Payer: Cigna Medicare Advantage	$13,123.52
Rate for Payer: Clover Medicare Advantage	$12,467.34
Rate for Payer: EmblemHealth Commercial	$39,370.56
Rate for Payer: Humana Medicare Advantage	$13,517.23
Rate for Payer: Oxford Commercial	$12,765.40
Rate for Payer: UnitedHealthcare Commercial	$14,489.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,123.52
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13,910.93
Rate for Payer: Wellcare Medicare Advantage	$13,123.52

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$66,599.61

Service Code	MSDRG 196
Min. Negotiated Rate	$20,594.23
Max. Negotiated Rate	$66,599.61
Rate for Payer: Aetna Commercial	$63,636.17
Rate for Payer: Aetna Medicare Advantage	$20,594.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52,377.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52,377.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,199.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52,377.30
Rate for Payer: Cigna Commercial	$40,614.43
Rate for Payer: Cigna Medicare Advantage	$22,199.87
Rate for Payer: Clover Medicare Advantage	$21,089.88
Rate for Payer: EmblemHealth Commercial	$66,599.61
Rate for Payer: Humana Medicare Advantage	$22,865.87
Rate for Payer: Oxford Commercial	$25,382.84
Rate for Payer: UnitedHealthcare Commercial	$28,811.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,199.87
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$23,531.86
Rate for Payer: Wellcare Medicare Advantage	$22,199.87

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$32,610.45

Service Code	MSDRG 198
Min. Negotiated Rate	$7,815.59
Max. Negotiated Rate	$32,610.45
Rate for Payer: Aetna Commercial	$24,150.17
Rate for Payer: Aetna Medicare Advantage	$7,815.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,502.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,502.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,870.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,502.26
Rate for Payer: Cigna Commercial	$15,413.34
Rate for Payer: Cigna Medicare Advantage	$10,870.15
Rate for Payer: Clover Medicare Advantage	$10,326.64
Rate for Payer: EmblemHealth Commercial	$32,610.45
Rate for Payer: Humana Medicare Advantage	$11,196.25
Rate for Payer: Oxford Commercial	$9,632.89
Rate for Payer: UnitedHealthcare Commercial	$10,934.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,870.15
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,522.36
Rate for Payer: Wellcare Medicare Advantage	$10,870.15

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
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

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
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

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706250
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270706103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$4,650.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270706103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERT BODY FUSION DEV 17.5

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706250
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$4,650.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

Know your out-of-pocket cost for care.

All Charges