Heights University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2500265
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2692142
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	7412071
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	321099153
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2500266
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5792287
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2500266
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5100850
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	321099153
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	7412071
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2692142
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	366899153
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5792287
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	366899153
Hospital Revenue Code	370
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$19.62
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$32.70

MOD SED SAME MD EA ADD 15MIN

Facility

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5100850
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MODULAR BROACHED BODY SZ 5

Facility

$36,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270675959
Hospital Revenue Code	278
Min. Negotiated Rate	$5,415.00
Max. Negotiated Rate	$18,050.00
Rate for Payer: Aetna Commercial	$10,830.00
Rate for Payer: Aetna Medicare Advantage	$10,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,205.50
Rate for Payer: Cigna Commercial	$18,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,736.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,415.00

MODULAR BROACHED BODY SZ 5

Facility

$36,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270675959
Hospital Revenue Code	278
Min. Negotiated Rate	$5,415.00
Max. Negotiated Rate	$8,736.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,736.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,415.00

MODULAR CUP 10 DEG LINER 62

Facility

$6,220.00

Hospital Charge Code	270666713
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$3,110.00
Rate for Payer: Aetna Commercial	$1,866.00
Rate for Payer: Aetna Medicare Advantage	$1,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.10
Rate for Payer: Cigna Commercial	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 10 DEG LINER 62

Facility

$6,220.00

Hospital Charge Code	270666713
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 10 DEGREE 58X36

Facility

$6,220.00

Hospital Charge Code	270667173
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 10 DEGREE 58X36

Facility

$6,220.00

Hospital Charge Code	270667173
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$3,110.00
Rate for Payer: Aetna Commercial	$1,866.00
Rate for Payer: Aetna Medicare Advantage	$1,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.10
Rate for Payer: Cigna Commercial	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 62MM MULTI-HOLE

Facility

$8,660.00

Hospital Charge Code	270666712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP 62MM MULTI-HOLE

Facility

$8,660.00

Hospital Charge Code	270666712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$2,598.00
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP NEU LINR LONG56X36

Facility

$6,221.55

Hospital Charge Code	270662349
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$1,866.46
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

MODULAR CUP NEU LINR LONG56X36

Facility

$6,221.55

Hospital Charge Code	270662349
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

Know your out-of-pocket cost for care.

All Charges