Heights University Hospital

All Charges

Charge

Type

Setting

Price

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$244.27
Max. Negotiated Rate	$244.27
Rate for Payer: Qualcare PPO/HMO/WC	$244.27

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$44,262.50
Rate for Payer: Aetna Commercial	$26,557.50
Rate for Payer: Aetna Medicare Advantage	$26,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,573.88
Rate for Payer: Cigna Commercial	$44,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$21,423.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$5,316.10
Max. Negotiated Rate	$8,576.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$5,316.10
Max. Negotiated Rate	$17,720.35
Rate for Payer: Aetna Commercial	$10,632.21
Rate for Payer: Aetna Medicare Advantage	$10,632.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,037.38
Rate for Payer: Cigna Commercial	$17,720.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$7,728.75
Max. Negotiated Rate	$12,469.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$7,728.75
Max. Negotiated Rate	$25,762.50
Rate for Payer: Aetna Commercial	$15,457.50
Rate for Payer: Aetna Medicare Advantage	$15,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,138.88
Rate for Payer: Cigna Commercial	$25,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$2,958.75
Max. Negotiated Rate	$9,862.50
Rate for Payer: Aetna Commercial	$5,917.50
Rate for Payer: Aetna Medicare Advantage	$5,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,029.88
Rate for Payer: Cigna Commercial	$9,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$2,958.75
Max. Negotiated Rate	$4,773.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$10,155.38
Max. Negotiated Rate	$16,384.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$10,155.38
Max. Negotiated Rate	$33,851.28
Rate for Payer: Aetna Commercial	$20,310.76
Rate for Payer: Aetna Medicare Advantage	$20,310.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,264.15
Rate for Payer: Cigna Commercial	$33,851.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$9,817.88
Max. Negotiated Rate	$32,726.28
Rate for Payer: Aetna Commercial	$19,635.76
Rate for Payer: Aetna Medicare Advantage	$19,635.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,690.40
Rate for Payer: Cigna Commercial	$32,726.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$9,817.88
Max. Negotiated Rate	$15,839.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$9,138.75
Max. Negotiated Rate	$30,462.50
Rate for Payer: Aetna Commercial	$18,277.50
Rate for Payer: Aetna Medicare Advantage	$18,277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,535.88
Rate for Payer: Cigna Commercial	$30,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$9,138.75
Max. Negotiated Rate	$14,743.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$9,607.50
Max. Negotiated Rate	$32,025.00
Rate for Payer: Aetna Commercial	$19,215.00
Rate for Payer: Aetna Medicare Advantage	$19,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,332.75
Rate for Payer: Cigna Commercial	$32,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$9,607.50
Max. Negotiated Rate	$15,500.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50

PENILE PROTHESIS 16CMX14MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694753
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$44,262.50
Rate for Payer: Aetna Commercial	$26,557.50
Rate for Payer: Aetna Medicare Advantage	$26,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,573.88
Rate for Payer: Cigna Commercial	$44,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE PROTHESIS 16CMX14MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694753
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$21,423.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE TIP 18CM CX

Facility

$41,915.00

Hospital Charge Code	270674330
Hospital Revenue Code	278
Min. Negotiated Rate	$6,287.25
Max. Negotiated Rate	$20,957.50
Rate for Payer: Aetna Commercial	$12,574.50
Rate for Payer: Aetna Medicare Advantage	$12,574.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,688.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,688.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,383.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,688.33
Rate for Payer: Cigna Commercial	$20,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,143.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,287.25

PENILE TIP 18CM CX

Facility

$41,915.00

Hospital Charge Code	270674330
Hospital Revenue Code	278
Min. Negotiated Rate	$6,287.25
Max. Negotiated Rate	$10,143.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,383.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,143.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,287.25

PENIS PROCEDURES WITH CC/MCC

Facility

$79,368.03

Service Code	MSDRG 709
Min. Negotiated Rate	$25,133.21
Max. Negotiated Rate	$79,368.03
Rate for Payer: Aetna Commercial	$78,469.53
Rate for Payer: Aetna Medicare Advantage	$25,394.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59,820.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59,820.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,456.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59,820.39
Rate for Payer: Cigna Commercial	$50,081.52
Rate for Payer: Cigna Medicare Advantage	$26,456.01
Rate for Payer: Clover Medicare Advantage	$25,133.21
Rate for Payer: EmblemHealth Commercial	$79,368.03
Rate for Payer: Humana Medicare Advantage	$27,249.69
Rate for Payer: Oxford Commercial	$31,299.49
Rate for Payer: UnitedHealthcare Commercial	$35,527.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,456.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$28,043.37
Rate for Payer: Wellcare Medicare Advantage	$26,456.01

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$52,493.10

Service Code	MSDRG 710
Min. Negotiated Rate	$15,290.71
Max. Negotiated Rate	$52,493.10
Rate for Payer: Aetna Commercial	$47,248.29
Rate for Payer: Aetna Medicare Advantage	$15,290.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,837.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,497.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,837.10
Rate for Payer: Cigna Commercial	$30,155.23
Rate for Payer: Cigna Medicare Advantage	$17,497.70
Rate for Payer: Clover Medicare Advantage	$16,622.81
Rate for Payer: EmblemHealth Commercial	$52,493.10
Rate for Payer: Humana Medicare Advantage	$18,022.63
Rate for Payer: Oxford Commercial	$18,846.14
Rate for Payer: UnitedHealthcare Commercial	$21,392.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,497.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18,547.56
Rate for Payer: Wellcare Medicare Advantage	$17,497.70

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$16,846.97

Service Code	APR-DRG 4832
Min. Negotiated Rate	$12,232.19
Max. Negotiated Rate	$16,846.97
Rate for Payer: Aetna Better Health Medicaid	$16,516.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,846.97
Rate for Payer: Wellpoint Medicaid Managed Care	$12,232.19

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$25,521.86

Service Code	APR-DRG 4833
Min. Negotiated Rate	$20,534.00
Max. Negotiated Rate	$25,521.86
Rate for Payer: Aetna Better Health Medicaid	$25,021.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,521.86
Rate for Payer: Wellpoint Medicaid Managed Care	$20,534.00

Know your out-of-pocket cost for care.

All Charges