Heights University Hospital

All Charges

Charge

Type

Setting

Price

MODULE PEDS EMERG COMPLETE

Facility

$166.92

Hospital Charge Code	270611450
Hospital Revenue Code	271
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$83.46
Rate for Payer: Aetna Commercial	$50.08
Rate for Payer: Aetna Medicare Advantage	$50.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.56
Rate for Payer: Cigna Commercial	$83.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: Oxford Commercial	$83.46
Rate for Payer: Qualcare PPO/HMO/WC	$25.04
Rate for Payer: UnitedHealthcare Commercial	$83.46

MODULE YELLOW COMBO PACK

Facility

$197.50

Hospital Charge Code	270645753
Hospital Revenue Code	271
Min. Negotiated Rate	$29.62
Max. Negotiated Rate	$29.62
Rate for Payer: Qualcare PPO/HMO/WC	$29.62

MODULE YELLOW COMBO PACK

Facility

$197.50

Hospital Charge Code	270645753
Hospital Revenue Code	271
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$98.75
Rate for Payer: Aetna Commercial	$59.25
Rate for Payer: Aetna Medicare Advantage	$59.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.36
Rate for Payer: Cigna Commercial	$98.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.68
Rate for Payer: Oxford Commercial	$98.75
Rate for Payer: Qualcare PPO/HMO/WC	$29.62
Rate for Payer: UnitedHealthcare Commercial	$98.75

MODULUS TLIF-O 10X10X25MM 4D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 10X10X25MM 4D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$9,750.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 10X10X25MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697648
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$9,750.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 10X10X25MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697648
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 12X10X30MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697646
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 12X10X30MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697646
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$9,750.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 7X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693363
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 7X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693363
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$9,750.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODURETIC/TAB

Facility

$3.00

Hospital Charge Code	60633442
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

MODURETIC/TAB

Facility

$3.00

Hospital Charge Code	60633442
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MOLDABLE BONE MATRIX/2.5CC ALL

Facility

$4,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270704126
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,064.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

MOLDABLE BONE MATRIX/2.5CC ALL

Facility

$4,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270704126
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,320.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

MOLD FEM CEMENT SPACER 60MM

Facility

$13,670.00

Hospital Charge Code	270677428
Hospital Revenue Code	272
Min. Negotiated Rate	$2,050.50
Max. Negotiated Rate	$2,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,050.50

MOLD FEM CEMENT SPACER 60MM

Facility

$13,670.00

Hospital Charge Code	270677428
Hospital Revenue Code	272
Min. Negotiated Rate	$1,777.10
Max. Negotiated Rate	$6,835.00
Rate for Payer: Aetna Commercial	$4,101.00
Rate for Payer: Aetna Medicare Advantage	$4,101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,485.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,485.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,485.85
Rate for Payer: Cigna Commercial	$6,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,777.10
Rate for Payer: Oxford Commercial	$6,835.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,050.50
Rate for Payer: UnitedHealthcare Commercial	$6,835.00

MOLD ID

Facility

$70.95

Service Code	HCPCS 87107
Hospital Charge Code	39900267
Hospital Revenue Code	309
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.81
Rate for Payer: Cigna Commercial	$10.32
Rate for Payer: Cigna Medicare Advantage	$5.16
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.64
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.94
Rate for Payer: Wellcare Medicare Advantage	$10.32

MOLD ID

Facility

$70.95

Service Code	HCPCS 87107
Hospital Charge Code	39900267
Hospital Revenue Code	309
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.64

MOLD ID FUNGAL IDENTIFICATION

Facility

$93.65

Service Code	HCPCS 87106
Hospital Charge Code	3006780
Hospital Revenue Code	309
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

MOLD ID FUNGAL IDENTIFICATION

Facility

$93.65

Service Code	HCPCS 87106
Hospital Charge Code	3006780
Hospital Revenue Code	309
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.81
Rate for Payer: Cigna Commercial	$10.32
Rate for Payer: Cigna Medicare Advantage	$5.16
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.94
Rate for Payer: Wellcare Medicare Advantage	$10.32

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.69

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.69

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges