Heights University Hospital

All Charges

Charge

Type

Setting

Price

REV HIP/ANCA TIBA W SCRW H70MM

Facility

$26,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678329
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

REV HIP/ANCA TIBA W SCRW H70MM

Facility

$26,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678329
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$7,875.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

REV HIP/TIBA DIA-18MM L-140MM

Facility

$28,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678330
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$8,400.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

REV HIP/TIBA DIA-18MM L-140MM

Facility

$28,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678330
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

REV HIP TIB NCK W SCRW H80MM

Facility

$26,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$7,875.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

REV HIP TIB NCK W SCRW H80MM

Facility

$26,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

REVISE AV FISTULA - GRAFT

Facility

$38,857.60

Service Code	HCPCS 36832
Hospital Charge Code	16000948
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$11,657.28
Rate for Payer: Aetna Medicare Advantage	$11,657.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,908.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,908.69
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	$9,908.69
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,051.49
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,828.64
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

REVISE AV FISTULA - GRAFT

Facility

$38,857.60

Service Code	HCPCS 36832
Hospital Charge Code	16000948
Hospital Revenue Code	360
Min. Negotiated Rate	$5,828.64
Max. Negotiated Rate	$5,828.64
Rate for Payer: Qualcare PPO/HMO/WC	$5,828.64

REVISE CERV ARTIFIC DISC

Facility

$44,286.00

Service Code	HCPCS 22861
Hospital Charge Code	160000229
Hospital Revenue Code	360
Min. Negotiated Rate	$6,642.90
Max. Negotiated Rate	$6,642.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90

REVISE CERV ARTIFIC DISC

Facility

$44,286.00

Service Code	HCPCS 22861
Hospital Charge Code	160000229
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$41,754.94
Rate for Payer: Aetna Commercial	$13,285.80
Rate for Payer: Aetna Medicare Advantage	$13,285.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,292.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,292.93
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	$11,292.93
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,757.18
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,642.90
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

REVISED TOTAL HIP ARTHROPL

Facility

$22,885.90

Service Code	HCPCS 27138
Hospital Charge Code	1600000597
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$30,573.98
Rate for Payer: Aetna Commercial	$6,865.77
Rate for Payer: Aetna Medicare Advantage	$6,865.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,835.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,835.90
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	$5,835.90
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,975.17
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,432.89
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

REVISED TOTAL HIP ARTHROPL

Facility

$22,885.90

Service Code	HCPCS 27138
Hospital Charge Code	1600000597
Hospital Revenue Code	360
Min. Negotiated Rate	$3,432.89
Max. Negotiated Rate	$3,432.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,432.89

REVISE FINGER JOINT EACH

Facility

$10,580.92

Service Code	HCPCS 26135
Hospital Charge Code	16000699
Hospital Revenue Code	360
Min. Negotiated Rate	$1,375.52
Max. Negotiated Rate	$7,791.93
Rate for Payer: Aetna Commercial	$3,174.28
Rate for Payer: Aetna Medicare Advantage	$3,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,698.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,698.13
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	$2,698.13
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,375.52
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,587.14
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REVISE FINGER JOINT EACH

Facility

$10,580.92

Service Code	HCPCS 26135
Hospital Charge Code	16000699
Hospital Revenue Code	360
Min. Negotiated Rate	$1,587.14
Max. Negotiated Rate	$1,587.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,587.14

REVISE FINGER/TOE NERVE

Facility

$9,553.80

Service Code	HCPCS 64702
Hospital Charge Code	323064702
Hospital Revenue Code	450
Min. Negotiated Rate	$1,433.07
Max. Negotiated Rate	$1,433.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.07

REVISE FINGER/TOE NERVE

Facility

$9,553.80

Service Code	HCPCS 64702
Hospital Charge Code	323064702
Hospital Revenue Code	450
Min. Negotiated Rate	$166.53
Max. Negotiated Rate	$4,650.22
Rate for Payer: Aetna Commercial	$2,866.14
Rate for Payer: Aetna Medicare Advantage	$2,866.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,436.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,436.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,436.22
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.07

REVISE FINGER/TOE NERVE-F6

Facility

$16,437.00

Service Code	HCPCS 64702
Hospital Charge Code	16000526
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$4,931.10
Rate for Payer: Aetna Medicare Advantage	$4,931.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,191.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,191.44
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	$4,191.44
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,136.81
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

REVISE FINGER/TOE NERVE-F6

Facility

$16,437.00

Service Code	HCPCS 64702
Hospital Charge Code	16000526
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

REVISE LAGB

Facility

$112,126.91

Service Code	HCPCS 43771
Hospital Charge Code	1600164
Hospital Revenue Code	361
Min. Negotiated Rate	$1,316.76
Max. Negotiated Rate	$33,638.07
Rate for Payer: Aetna Commercial	$33,638.07
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,000.00
Rate for Payer: Cigna Commercial	$1,316.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,576.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

REVISE LAGB

Facility

$112,126.91

Service Code	HCPCS 43771
Hospital Charge Code	1600164
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

REVISE LOW BACK NERVE(S)

Facility

$9,663.00

Service Code	HCPCS 64714
Hospital Charge Code	16001044
Hospital Revenue Code	360
Min. Negotiated Rate	$1,449.45
Max. Negotiated Rate	$1,449.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,449.45

REVISE LOW BACK NERVE(S)

Facility

$9,663.00

Service Code	HCPCS 64714
Hospital Charge Code	16001044
Hospital Revenue Code	360
Min. Negotiated Rate	$1,256.19
Max. Negotiated Rate	$5,529.00
Rate for Payer: Aetna Commercial	$2,898.90
Rate for Payer: Aetna Medicare Advantage	$2,898.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,464.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,464.07
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	$2,464.07
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,256.19
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,449.45
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

REVISE LOWER LEG TENDON

Facility

$22,425.68

Service Code	HCPCS 27691
Hospital Charge Code	16000565
Hospital Revenue Code	360
Min. Negotiated Rate	$569.19
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Better Health Medicaid	$569.19
Rate for Payer: Aetna Commercial	$6,727.70
Rate for Payer: Aetna Medicare Advantage	$6,727.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,718.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,718.55
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	$5,718.55
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.34
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85
Rate for Payer: UnitedHealthcare Commercial	$8,580.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$580.57
Rate for Payer: Wellpoint Medicaid Managed Care	$569.19

REVISE LOWER LEG TENDON

Facility

$22,425.68

Service Code	HCPCS 27691
Hospital Charge Code	16000565
Hospital Revenue Code	360
Min. Negotiated Rate	$3,363.85
Max. Negotiated Rate	$3,363.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85

REVISE RECONSTR BREAST

Facility

$42,601.70

Service Code	HCPCS 19380
Hospital Charge Code	16000790
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

Know your out-of-pocket cost for care.

All Charges