Heights University Hospital

All Charges

Charge

Type

Setting

Price

PLUG MESH PROLOOP MEDIUM 13704

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651873
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

PLUG MESH PROLOOP MEDIUM 13704

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651873
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$311.15
Rate for Payer: Aetna Commercial	$186.69
Rate for Payer: Aetna Medicare Advantage	$186.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.69
Rate for Payer: Cigna Commercial	$311.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

PLUG MESH PROLOOP SMALL

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651874
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$311.15
Rate for Payer: Aetna Commercial	$186.69
Rate for Payer: Aetna Medicare Advantage	$186.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.69
Rate for Payer: Cigna Commercial	$311.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

PLUG MESH PROLOOP SMALL

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651874
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

PLUG MESH PROLOOP XL

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270651876
Hospital Revenue Code	278
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$336.88
Rate for Payer: Aetna Commercial	$202.12
Rate for Payer: Aetna Medicare Advantage	$202.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.81
Rate for Payer: Cigna Commercial	$336.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06

PLUG MESH PROLOOP XL

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270651876
Hospital Revenue Code	278
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$163.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06

PLUG PERFIX MESH *******

Facility

$281.00

Hospital Charge Code	1608348
Hospital Revenue Code	272
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

PLUG PERFIX MESH *******

Facility

$281.00

Hospital Charge Code	1608348
Hospital Revenue Code	272
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$84.30
Rate for Payer: Aetna Medicare Advantage	$84.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.66
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.53
Rate for Payer: Oxford Commercial	$140.50
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$140.50

PLUG POLY****

Facility

$247.00

Hospital Charge Code	1601772
Hospital Revenue Code	272
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$123.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$123.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$123.50

PLUG POLY****

Facility

$247.00

Hospital Charge Code	1601772
Hospital Revenue Code	272
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

PLUG SDK BREAKOFF SCREW 859855

Facility

$890.45

Hospital Charge Code	270616993
Hospital Revenue Code	278
Min. Negotiated Rate	$133.57
Max. Negotiated Rate	$215.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$133.57

PLUG SDK BREAKOFF SCREW 859855

Facility

$890.45

Hospital Charge Code	270616993
Hospital Revenue Code	278
Min. Negotiated Rate	$133.57
Max. Negotiated Rate	$445.23
Rate for Payer: Aetna Commercial	$267.13
Rate for Payer: Aetna Medicare Advantage	$267.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.06
Rate for Payer: Cigna Commercial	$445.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$133.57

PLUG SURGISIS ANAL FISTULA

Facility

$4,250.00

Hospital Charge Code	270637927
Hospital Revenue Code	272
Min. Negotiated Rate	$552.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.50
Rate for Payer: Oxford Commercial	$2,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Commercial	$2,125.00

PLUG SURGISIS ANAL FISTULA

Facility

$4,250.00

Hospital Charge Code	270637927
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

PLUG TRUFILL BCA LIQ 1GM

Facility

$23,754.00

Hospital Charge Code	270696473S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.10
Max. Negotiated Rate	$5,748.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,748.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,563.10

PLUG TRUFILL BCA LIQ 1GM

Facility

$23,754.00

Hospital Charge Code	270696473S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.10
Max. Negotiated Rate	$11,877.00
Rate for Payer: Aetna Commercial	$7,126.20
Rate for Payer: Aetna Medicare Advantage	$7,126.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,057.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,057.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,057.27
Rate for Payer: Cigna Commercial	$11,877.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,748.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,563.10

PLUME AWAY

Facility

$199.84

Hospital Charge Code	270663223
Hospital Revenue Code	270
Min. Negotiated Rate	$25.98
Max. Negotiated Rate	$99.92
Rate for Payer: Aetna Commercial	$59.95
Rate for Payer: Aetna Medicare Advantage	$59.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.96
Rate for Payer: Cigna Commercial	$99.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.98
Rate for Payer: Oxford Commercial	$99.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$99.92

PLUME AWAY

Facility

$199.84

Hospital Charge Code	270663223
Hospital Revenue Code	270
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190205
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$95.89
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190205
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

PL-VAS OV EP PROBLEM FOCUSED

Facility

$428.58

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$128.57
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV EP PROBLEM FOCUSED

Facility

$428.58

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$128.57
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

PL-VAS OV PROBLEM FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	83033020
Hospital Revenue Code	510
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: Qualcare PPO/HMO/WC	$39.00

Know your out-of-pocket cost for care.

All Charges