Heights University Hospital

All Charges

Charge

Type

Setting

Price

M CYTOGEN CHROMO IN SITU HYBRI

Facility

$153.75

Service Code	HCPCS 88272
Hospital Charge Code	38477169
Hospital Revenue Code	311
Min. Negotiated Rate	$23.06
Max. Negotiated Rate	$23.06
Rate for Payer: Qualcare PPO/HMO/WC	$23.06

M CYTOGEN CHROMO IN SITU HYBRI

Facility

$153.75

Service Code	HCPCS 88272
Hospital Charge Code	38477169
Hospital Revenue Code	311
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$149.12
Rate for Payer: Aetna Commercial	$131.87
Rate for Payer: Aetna Medicare Advantage	$40.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.12
Rate for Payer: Cigna Commercial	$40.70
Rate for Payer: Cigna Medicare Advantage	$20.35
Rate for Payer: Clover Medicare Advantage	$38.66
Rate for Payer: EmblemHealth Commercial	$122.10
Rate for Payer: Humana Medicare Advantage	$41.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.06
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$43.14
Rate for Payer: Wellcare Medicare Advantage	$40.70

M CYTOGEN CHROMO IN SITU HYBRI

Facility

$246.55

Service Code	HCPCS 88274
Hospital Charge Code	38477192
Hospital Revenue Code	311
Min. Negotiated Rate	$36.98
Max. Negotiated Rate	$36.98
Rate for Payer: Qualcare PPO/HMO/WC	$36.98

M CYTOGEN/CHROMO IN SITU HYBRI

Facility

$284.40

Service Code	HCPCS 88275
Hospital Charge Code	38477202
Hospital Revenue Code	311
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$42.66
Rate for Payer: Qualcare PPO/HMO/WC	$42.66

M CYTOGEN/CHROMO IN SITU HYBRI

Facility

$284.40

Service Code	HCPCS 88275
Hospital Charge Code	38477202
Hospital Revenue Code	311
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$187.56
Rate for Payer: Aetna Commercial	$165.86
Rate for Payer: Aetna Medicare Advantage	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.56
Rate for Payer: Cigna Commercial	$51.19
Rate for Payer: Cigna Medicare Advantage	$25.59
Rate for Payer: Clover Medicare Advantage	$48.63
Rate for Payer: EmblemHealth Commercial	$153.57
Rate for Payer: Humana Medicare Advantage	$52.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.66
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.19
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$54.26
Rate for Payer: Wellcare Medicare Advantage	$51.19

M CYTOGENETICS DNA PROBE EA

Facility

$128.19

Service Code	HCPCS 88271
Hospital Charge Code	38477151
Hospital Revenue Code	311
Min. Negotiated Rate	$19.23
Max. Negotiated Rate	$19.23
Rate for Payer: Qualcare PPO/HMO/WC	$19.23

M CYTOGENETICS DNA PROBE EA

Facility

$128.19

Service Code	HCPCS 88271
Hospital Charge Code	38477151
Hospital Revenue Code	311
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$69.40
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.48
Rate for Payer: Cigna Commercial	$21.42
Rate for Payer: Cigna Medicare Advantage	$10.71
Rate for Payer: Clover Medicare Advantage	$20.35
Rate for Payer: EmblemHealth Commercial	$64.26
Rate for Payer: Humana Medicare Advantage	$22.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.23
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.42
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$22.71
Rate for Payer: Wellcare Medicare Advantage	$21.42

MD-60 CONTRAST MEDIA

Facility

$28.00

Hospital Charge Code	270331611
Hospital Revenue Code	272
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

MD-60 CONTRAST MEDIA

Facility

$28.00

Hospital Charge Code	270331611
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

MD GASTROVIEW 30ML

Facility

$132.66

Service Code	NDC 19481604
Hospital Charge Code	60635832
Hospital Revenue Code	255
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.90

MD GASTROVIEW 30ML

Facility

$132.66

Service Code	NDC 19481604
Hospital Charge Code	60635832
Hospital Revenue Code	255
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$66.33
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare Advantage	$39.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.83
Rate for Payer: Cigna Commercial	$66.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.25
Rate for Payer: Oxford Commercial	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$19.90
Rate for Payer: UnitedHealthcare Commercial	$66.33

MD GASTROVIEW SOL.BULK

Facility

$50.00

Hospital Charge Code	60635833
Hospital Revenue Code	255
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$25.00

MD GASTROVIEW SOL.BULK

Facility

$50.00

Hospital Charge Code	60635833
Hospital Revenue Code	255
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MD HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687429
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

MD HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687429
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

MDI SIZE 3

Facility

$18,625.00

Hospital Charge Code	270656321
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.75
Max. Negotiated Rate	$4,507.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75

MDI SIZE 3

Facility

$18,625.00

Hospital Charge Code	270656321
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.75
Max. Negotiated Rate	$9,312.50
Rate for Payer: Aetna Commercial	$5,587.50
Rate for Payer: Aetna Medicare Advantage	$5,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,749.38
Rate for Payer: Cigna Commercial	$9,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75

MDLR CP 10 DEG NEU 50/52/54X32

Facility

$4,454.05

Hospital Charge Code	270663144
Hospital Revenue Code	278
Min. Negotiated Rate	$668.11
Max. Negotiated Rate	$1,077.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,077.88
Rate for Payer: Qualcare PPO/HMO/WC	$668.11

MDLR CP 10 DEG NEU 50/52/54X32

Facility

$4,454.05

Hospital Charge Code	270663144
Hospital Revenue Code	278
Min. Negotiated Rate	$668.11
Max. Negotiated Rate	$2,227.03
Rate for Payer: Aetna Commercial	$1,336.21
Rate for Payer: Aetna Medicare Advantage	$1,336.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,135.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,135.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,135.78
Rate for Payer: Cigna Commercial	$2,227.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,077.88
Rate for Payer: Qualcare PPO/HMO/WC	$668.11

MD SCREW 2.7MM X 16MM

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270701903
Hospital Revenue Code	278
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$595.00
Rate for Payer: Aetna Commercial	$357.00
Rate for Payer: Aetna Medicare Advantage	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.45
Rate for Payer: Cigna Commercial	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.98
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

MD SCREW 2.7MM X 16MM

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270701903
Hospital Revenue Code	278
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.98
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

MD SCREW 2.7MM X 18MM

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270681159
Hospital Revenue Code	278
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$595.00
Rate for Payer: Aetna Commercial	$357.00
Rate for Payer: Aetna Medicare Advantage	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.45
Rate for Payer: Cigna Commercial	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.98
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

MD SCREW 2.7MM X 18MM

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270681159
Hospital Revenue Code	278
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.98
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

MD SCREW 2.7MM X 20MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270688186
Hospital Revenue Code	278
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$371.25
Rate for Payer: Aetna Commercial	$222.75
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.34
Rate for Payer: Cigna Commercial	$371.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: Qualcare PPO/HMO/WC	$111.38

MD SCREW 2.7MM X 20MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270688186
Hospital Revenue Code	278
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$179.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: Qualcare PPO/HMO/WC	$111.38

Know your out-of-pocket cost for care.

All Charges