Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLT NARROW SELF COMP 6-9 H***

Facility

$237.00

Hospital Charge Code	1602531
Hospital Revenue Code	274
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$57.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.35
Rate for Payer: Qualcare PPO/HMO/WC	$35.55

PLT NARROW STANDARD 10&13 HOLE

Facility

$213.50

Hospital Charge Code	1603018
Hospital Revenue Code	274
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$106.75
Rate for Payer: Aetna Commercial	$64.05
Rate for Payer: Aetna Medicare Advantage	$64.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.44
Rate for Payer: Cigna Commercial	$106.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.67
Rate for Payer: Qualcare PPO/HMO/WC	$32.02

PLT NARROW STANDARD 10&13 HOLE

Facility

$213.50

Hospital Charge Code	1603018
Hospital Revenue Code	274
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$51.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.67
Rate for Payer: Qualcare PPO/HMO/WC	$32.02

PLT NARROW STANDARD 14 HOLE

Facility

$251.00

Hospital Charge Code	1603026
Hospital Revenue Code	274
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$75.30
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.74
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

PLT NARROW STANDARD 14 HOLE

Facility

$251.00

Hospital Charge Code	1603026
Hospital Revenue Code	274
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$60.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.74
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

PLT NARROW STANDARD 2 HOLE

Facility

$148.50

Hospital Charge Code	1602952
Hospital Revenue Code	274
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$74.25
Rate for Payer: Aetna Commercial	$44.55
Rate for Payer: Aetna Medicare Advantage	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.87
Rate for Payer: Cigna Commercial	$74.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.94
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

PLT NARROW STANDARD 2 HOLE

Facility

$148.50

Hospital Charge Code	1602952
Hospital Revenue Code	274
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.94
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

PLT NARROW STANDARD 3&4 HOLE

Facility

$149.55

Hospital Charge Code	1602960
Hospital Revenue Code	274
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$74.78
Rate for Payer: Aetna Commercial	$44.87
Rate for Payer: Aetna Medicare Advantage	$44.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.14
Rate for Payer: Cigna Commercial	$74.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.19
Rate for Payer: Qualcare PPO/HMO/WC	$22.43

PLT NARROW STANDARD 3&4 HOLE

Facility

$149.55

Hospital Charge Code	1602960
Hospital Revenue Code	274
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$36.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.19
Rate for Payer: Qualcare PPO/HMO/WC	$22.43

PLT NARROW STANDARD 5 HOLE

Facility

$151.80

Hospital Charge Code	1602978
Hospital Revenue Code	274
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.74
Rate for Payer: Qualcare PPO/HMO/WC	$22.77

PLT NARROW STANDARD 5 HOLE

Facility

$151.80

Hospital Charge Code	1602978
Hospital Revenue Code	274
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$75.90
Rate for Payer: Aetna Commercial	$45.54
Rate for Payer: Aetna Medicare Advantage	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.71
Rate for Payer: Cigna Commercial	$75.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.74
Rate for Payer: Qualcare PPO/HMO/WC	$22.77

PLT NARROW STANDARD 6 HOLE

Facility

$170.00

Hospital Charge Code	1602986
Hospital Revenue Code	274
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

PLT NARROW STANDARD 6 HOLE

Facility

$170.00

Hospital Charge Code	1602986
Hospital Revenue Code	274
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

PLT NARROW STANDARD 7&8 HOLE

Facility

$174.05

Hospital Charge Code	1602994
Hospital Revenue Code	274
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$87.03
Rate for Payer: Aetna Commercial	$52.22
Rate for Payer: Aetna Medicare Advantage	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.38
Rate for Payer: Cigna Commercial	$87.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

PLT NARROW STANDARD 7&8 HOLE

Facility

$174.05

Hospital Charge Code	1602994
Hospital Revenue Code	274
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

PLT NARROW STANDARD 9 HOLE

Facility

$181.15

Hospital Charge Code	1603000
Hospital Revenue Code	274
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$54.34
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

PLT NARROW STANDARD 9 HOLE

Facility

$181.15

Hospital Charge Code	1603000
Hospital Revenue Code	274
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$43.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

PLT NARR SELF COMP10-12 HL***

Facility

$300.00

Hospital Charge Code	1602549
Hospital Revenue Code	274
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

PLT NARR SELF COMP10-12 HL***

Facility

$300.00

Hospital Charge Code	1602549
Hospital Revenue Code	274
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

PLT NARR SELF COMP 13HL*****

Facility

$365.00

Hospital Charge Code	1602556
Hospital Revenue Code	274
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$88.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.33
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

PLT NARR SELF COMP 13HL*****

Facility

$365.00

Hospital Charge Code	1602556
Hospital Revenue Code	274
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$109.50
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.33
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

PLT PEG TIB SZ 3 NXGN 59703501

Facility

$8,235.30

Hospital Charge Code	270638276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.30
Max. Negotiated Rate	$1,992.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,647.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,992.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,235.30

PLT PEG TIB SZ 3 NXGN 59703501

Facility

$8,235.30

Hospital Charge Code	270638276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.30
Max. Negotiated Rate	$4,117.65
Rate for Payer: Aetna Commercial	$2,470.59
Rate for Payer: Aetna Medicare Advantage	$2,470.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,647.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,100.00
Rate for Payer: Cigna Commercial	$4,117.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,992.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,235.30

PLT PERIAR 6 HOLE RT2347-17-06

Facility

$2,008.40

Hospital Charge Code	270634933
Hospital Revenue Code	278
Min. Negotiated Rate	$301.26
Max. Negotiated Rate	$486.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.03
Rate for Payer: Qualcare PPO/HMO/WC	$301.26

PLT PERIAR 6 HOLE RT2347-17-06

Facility

$2,008.40

Hospital Charge Code	270634933
Hospital Revenue Code	278
Min. Negotiated Rate	$301.26
Max. Negotiated Rate	$1,004.20
Rate for Payer: Aetna Commercial	$602.52
Rate for Payer: Aetna Medicare Advantage	$602.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.14
Rate for Payer: Cigna Commercial	$1,004.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.03
Rate for Payer: Qualcare PPO/HMO/WC	$301.26

Know your out-of-pocket cost for care.

All Charges