Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$309.33
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$4,071.00
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$309.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PLP29371

Facility

$8,475.00

Hospital Charge Code	270657271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

PLP29371

Facility

$8,475.00

Hospital Charge Code	270657271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$2,542.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$130.00

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$6,358.40
Max. Negotiated Rate	$6,358.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,716.79
Rate for Payer: Aetna Commercial	$12,716.79
Rate for Payer: Aetna Medicare Advantage	$12,716.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,809.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,809.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,809.27
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,510.61
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

PLT 12HOLE 4.0mmx144MmL427042S

Facility

$2,719.50

Hospital Charge Code	270638778
Hospital Revenue Code	278
Min. Negotiated Rate	$407.93
Max. Negotiated Rate	$658.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.12
Rate for Payer: Qualcare PPO/HMO/WC	$407.93

PLT 12HOLE 4.0mmx144MmL427042S

Facility

$2,719.50

Hospital Charge Code	270638778
Hospital Revenue Code	278
Min. Negotiated Rate	$407.93
Max. Negotiated Rate	$1,359.75
Rate for Payer: Aetna Commercial	$815.85
Rate for Payer: Aetna Medicare Advantage	$815.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$693.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$693.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$693.47
Rate for Payer: Cigna Commercial	$1,359.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.12
Rate for Payer: Qualcare PPO/HMO/WC	$407.93

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.52
Rate for Payer: Aetna Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.31
Rate for Payer: Cigna Commercial	$18.37
Rate for Payer: Cigna Medicare Advantage	$9.19
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.47
Rate for Payer: Wellcare Medicare Advantage	$18.37

PLT AGGREGATION

Facility

$152.15

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$22.82
Max. Negotiated Rate	$22.82
Rate for Payer: Qualcare PPO/HMO/WC	$22.82

PLT AGGREGATION

Facility

$152.15

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.27
Rate for Payer: Cigna Commercial	$24.91
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.82
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$26.40
Rate for Payer: Wellcare Medicare Advantage	$24.91

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.50
Max. Negotiated Rate	$2,543.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.50
Max. Negotiated Rate	$5,255.00
Rate for Payer: Aetna Commercial	$3,153.00
Rate for Payer: Aetna Medicare Advantage	$3,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,680.05
Rate for Payer: Cigna Commercial	$5,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50

PLT BROAD SELF COMP 5-7 HOLE

Facility

$337.00

Hospital Charge Code	1602572
Hospital Revenue Code	274
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$168.50
Rate for Payer: Aetna Commercial	$101.10
Rate for Payer: Aetna Medicare Advantage	$101.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.94
Rate for Payer: Cigna Commercial	$168.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.55
Rate for Payer: Qualcare PPO/HMO/WC	$50.55

PLT BROAD SELF COMP 5-7 HOLE

Facility

$337.00

Hospital Charge Code	1602572
Hospital Revenue Code	274
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$81.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.55
Rate for Payer: Qualcare PPO/HMO/WC	$50.55

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$730.29
Max. Negotiated Rate	$1,178.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: Qualcare PPO/HMO/WC	$730.29

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$730.29
Max. Negotiated Rate	$2,434.30
Rate for Payer: Aetna Commercial	$1,460.58
Rate for Payer: Aetna Medicare Advantage	$1,460.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.49
Rate for Payer: Cigna Commercial	$2,434.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: Qualcare PPO/HMO/WC	$730.29

PLT COUNT (BLUE TOP TURE)

Facility

$43.25

Service Code	HCPCS 85049
Hospital Charge Code	3002129
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.52
Rate for Payer: Aetna Medicare Advantage	$4.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.41
Rate for Payer: Cigna Commercial	$4.48
Rate for Payer: Cigna Medicare Advantage	$2.24
Rate for Payer: Clover Medicare Advantage	$4.26
Rate for Payer: EmblemHealth Commercial	$13.44
Rate for Payer: Humana Medicare Advantage	$4.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.48
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.75
Rate for Payer: Wellcare Medicare Advantage	$4.48

PLT COUNT (BLUE TOP TURE)

Facility

$43.25

Service Code	HCPCS 85049
Hospital Charge Code	3002129
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

PLT DBL Y 7mm MATR MID04503378

Facility

$1,205.00

Hospital Charge Code	270640450
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$291.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.61
Rate for Payer: Qualcare PPO/HMO/WC	$180.75

PLT DBL Y 7mm MATR MID04503378

Facility

$1,205.00

Hospital Charge Code	270640450
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$602.50
Rate for Payer: Aetna Commercial	$361.50
Rate for Payer: Aetna Medicare Advantage	$361.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.27
Rate for Payer: Cigna Commercial	$602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.61
Rate for Payer: Qualcare PPO/HMO/WC	$180.75

PLTE 10HLE NRW T-PLTE 57-10310

Facility

$3,250.00

Hospital Charge Code	270655359
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PLTE 10HLE NRW T-PLTE 57-10310

Facility

$3,250.00

Hospital Charge Code	270655359
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$975.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

Know your out-of-pocket cost for care.

All Charges