Heights University Hospital

All Charges

Charge

Type

Setting

Price

REPLACE REVISE BRAIN SHUNT

Facility

$30,813.76

Service Code	HCPCS 62230
Hospital Charge Code	1600000545
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$20,898.76
Rate for Payer: Aetna Commercial	$9,244.13
Rate for Payer: Aetna Medicare Advantage	$9,244.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,857.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,857.51
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	$7,857.51
Rate for Payer: Cigna Commercial	$20,898.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,005.79
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,622.06
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

REPLACE REVISE BRAIN SHUNT

Facility

$30,813.76

Service Code	HCPCS 62230
Hospital Charge Code	1600000545
Hospital Revenue Code	360
Min. Negotiated Rate	$4,622.06
Max. Negotiated Rate	$4,622.06
Rate for Payer: Qualcare PPO/HMO/WC	$4,622.06

REPLACE SAGITTAL SAW KEY

Facility

$1,311.00

Hospital Charge Code	270683665
Hospital Revenue Code	272
Min. Negotiated Rate	$170.43
Max. Negotiated Rate	$655.50
Rate for Payer: Aetna Commercial	$393.30
Rate for Payer: Aetna Medicare Advantage	$393.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.31
Rate for Payer: Cigna Commercial	$655.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.43
Rate for Payer: Oxford Commercial	$655.50
Rate for Payer: Qualcare PPO/HMO/WC	$196.65
Rate for Payer: UnitedHealthcare Commercial	$655.50

REPLACE SAGITTAL SAW KEY

Facility

$1,311.00

Hospital Charge Code	270683665
Hospital Revenue Code	272
Min. Negotiated Rate	$196.65
Max. Negotiated Rate	$196.65
Rate for Payer: Qualcare PPO/HMO/WC	$196.65

REPLACE TUNNELED CV CATH

Facility

$18,530.00

Service Code	HCPCS 36578
Hospital Charge Code	411093601
Hospital Revenue Code	481
Min. Negotiated Rate	$2,408.90
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$5,559.00
Rate for Payer: Aetna Medicare Advantage	$5,559.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,725.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,725.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,725.15
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,408.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,779.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPLACE TUNNELED CV CATH

Facility

$9,970.96

Service Code	HCPCS 36500
Hospital Charge Code	16000946
Hospital Revenue Code	360
Min. Negotiated Rate	$172.84
Max. Negotiated Rate	$2,991.29
Rate for Payer: Aetna Commercial	$2,991.29
Rate for Payer: Aetna Medicare Advantage	$2,991.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,542.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,542.59
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	$2,542.59
Rate for Payer: Cigna Commercial	$172.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,296.22
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,495.64
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

REPLACE TUNNELED CV CATH

Facility

$22,851.90

Service Code	HCPCS 36581
Hospital Charge Code	16000581
Hospital Revenue Code	360
Min. Negotiated Rate	$3,427.78
Max. Negotiated Rate	$3,427.78
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.78

REPLACE TUNNELED CV CATH

Facility

$9,970.96

Service Code	HCPCS 36500
Hospital Charge Code	16000946
Hospital Revenue Code	360
Min. Negotiated Rate	$1,495.64
Max. Negotiated Rate	$1,495.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,495.64

REPLACE TUNNELED CV CATH

Facility

$18,530.00

Service Code	HCPCS 36578
Hospital Charge Code	411093601
Hospital Revenue Code	481
Min. Negotiated Rate	$2,779.50
Max. Negotiated Rate	$2,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,779.50

REPLACE TUNNELED CV CATH

Facility

$22,851.90

Service Code	HCPCS 36581
Hospital Charge Code	16000581
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$6,855.57
Rate for Payer: Aetna Medicare Advantage	$6,855.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,827.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,827.23
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	$5,827.23
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.75
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.78
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REPLAC TUBE D/J PERC FLUR/CONT

Facility

$2,087.20

Service Code	HCPCS 49451
Hospital Charge Code	5700495
Hospital Revenue Code	450
Min. Negotiated Rate	$313.08
Max. Negotiated Rate	$313.08
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

REPLAC TUBE D/J PERC FLUR/CONT

Facility

$2,087.20

Service Code	HCPCS 49451
Hospital Charge Code	5700495
Hospital Revenue Code	450
Min. Negotiated Rate	$271.34
Max. Negotiated Rate	$2,159.89
Rate for Payer: Aetna Commercial	$626.16
Rate for Payer: Aetna Medicare Advantage	$626.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.24
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.34
Rate for Payer: Qualcare PPO/HMO/WC	$313.08

REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	2011505
Hospital Revenue Code	361
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

REPL EXT URET STENT-BI

Facility

$10,187.80

Service Code	HCPCS 5038750
Hospital Charge Code	2011505
Hospital Revenue Code	361
Min. Negotiated Rate	$1,324.41
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,056.34
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
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	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

REPL EXT URET STENT-BI

Facility

$6,757.27

Service Code	HCPCS 5038750
Hospital Charge Code	7412032
Hospital Revenue Code	361
Min. Negotiated Rate	$878.45
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,027.18
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-BI

Facility

$6,757.27

Service Code	HCPCS 5038750
Hospital Charge Code	7412032
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	7412033
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	2011506
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	2011506
Hospital Revenue Code	361
Min. Negotiated Rate	$878.45
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,027.18
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-LT

Facility

$6,757.27

Service Code	HCPCS 50387LT
Hospital Charge Code	7412033
Hospital Revenue Code	361
Min. Negotiated Rate	$878.45
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,027.18
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	7412034
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	7412034
Hospital Revenue Code	361
Min. Negotiated Rate	$878.45
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,027.18
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	2011507
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPL EXT URET STENT-RT

Facility

$6,757.27

Service Code	HCPCS 50387RT
Hospital Charge Code	2011507
Hospital Revenue Code	361
Min. Negotiated Rate	$878.45
Max. Negotiated Rate	$3,378.64
Rate for Payer: Aetna Commercial	$2,027.18
Rate for Payer: Aetna Medicare Advantage	$2,027.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,723.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,723.10
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	$1,723.10
Rate for Payer: Cigna Commercial	$3,378.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REPLIFORM 4X7

Facility

$3,912.00

Hospital Charge Code	270650889
Hospital Revenue Code	272
Min. Negotiated Rate	$586.80
Max. Negotiated Rate	$586.80
Rate for Payer: Qualcare PPO/HMO/WC	$586.80

Know your out-of-pocket cost for care.

All Charges