Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROSTATE SPECIFIC FREE

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	3007673A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROSTATE SPECIFIC TOTAL

Facility

$667.59

Service Code	HCPCS 84153
Hospital Charge Code	3007673B
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PROSTATE SPECIFIC TOTAL

Facility

$667.59

Service Code	HCPCS 84153
Hospital Charge Code	3007673B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$59.58
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.38
Rate for Payer: Cigna Commercial	$18.39
Rate for Payer: Cigna Medicare Advantage	$9.20
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.49
Rate for Payer: Wellcare Medicare Advantage	$18.39

PROSTATIC-DNA***

Facility

$424.00

Service Code	HCPCS 89399
Hospital Charge Code	3032216
Hospital Revenue Code	309
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$212.00
Rate for Payer: Aetna Commercial	$127.20
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

PROSTATIC-DNA***

Facility

$424.00

Service Code	HCPCS 89399
Hospital Charge Code	3032216
Hospital Revenue Code	309
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

PROSTECTOMY SUBTOTAL

Facility

$39,911.00

Service Code	HCPCS 55821
Hospital Charge Code	1600000882
Hospital Revenue Code	360
Min. Negotiated Rate	$822.21
Max. Negotiated Rate	$11,973.30
Rate for Payer: Aetna Commercial	$11,973.30
Rate for Payer: Aetna Medicare Advantage	$11,973.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,177.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,177.31
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	$10,177.31
Rate for Payer: Cigna Commercial	$822.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,188.43
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,986.65
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

PROSTECTOMY SUBTOTAL

Facility

$39,911.00

Service Code	HCPCS 55821
Hospital Charge Code	1600000882
Hospital Revenue Code	360
Min. Negotiated Rate	$5,986.65
Max. Negotiated Rate	$5,986.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,986.65

PROSTEP MICA DEPTH GAUGE 150MM

Facility

$660.00

Hospital Charge Code	270703496
Hospital Revenue Code	279
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

PROSTEP MICA DEPTH GAUGE 150MM

Facility

$660.00

Hospital Charge Code	270703496
Hospital Revenue Code	279
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$198.00
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$330.00

PROSTEP MICA SCR 4.0X38MM STRL

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702656
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X38MM STRL

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702656
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$853.58
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X40MM STRL

Facility

$2,845.25

Hospital Charge Code	270702755
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X40MM STRL

Facility

$2,845.25

Hospital Charge Code	270702755
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$853.58
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X52MM STRL

Facility

$2,845.25

Hospital Charge Code	270702756
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$853.58
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X52MM STRL

Facility

$2,845.25

Hospital Charge Code	270702756
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703026
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$853.58
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703025
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$853.58
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703026
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703025
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW 3.0 X 34MM

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270704139
Hospital Revenue Code	278
Min. Negotiated Rate	$864.43
Max. Negotiated Rate	$1,394.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: Qualcare PPO/HMO/WC	$864.43

PROSTEP MICA SCREW 3.0 X 34MM

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270704139
Hospital Revenue Code	278
Min. Negotiated Rate	$864.43
Max. Negotiated Rate	$2,881.43
Rate for Payer: Aetna Commercial	$1,728.86
Rate for Payer: Aetna Medicare Advantage	$1,728.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.53
Rate for Payer: Cigna Commercial	$2,881.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: Qualcare PPO/HMO/WC	$864.43

PROSTEP MICA SCREW 3X20MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703851
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 3X20MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703851
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$858.00
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 3X32MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703852
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$858.00
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 3X32MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703852
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

Know your out-of-pocket cost for care.

All Charges