Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$264.00
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

SCR LOC Ti 4.0 W/T25 01005412S

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637802
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	94061498
Hospital Revenue Code	403
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	85000904
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	9406406
Hospital Revenue Code	403
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCR MAMMO UNI INC CAD

Facility

$4,500.00

Service Code	HCPCS 7706752
Hospital Charge Code	2709038
Hospital Revenue Code	403
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,240.00

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

SCROTAL SUPPORT XL

Facility

$52.50

Hospital Charge Code	270647599
Hospital Revenue Code	270
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$8,580.00
Rate for Payer: Aetna Commercial	$6,092.56
Rate for Payer: Aetna Medicare Advantage	$6,092.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,178.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,178.68
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	$5,178.68
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,640.11
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$3,046.28
Max. Negotiated Rate	$3,046.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.27
Max. Negotiated Rate	$2,825.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$12,768.54
Rate for Payer: Aetna Commercial	$5,650.54
Rate for Payer: Aetna Medicare Advantage	$5,650.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,802.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,802.96
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	$4,802.96
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,448.57
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

SCR PER 3.5Mx12M W2.7M23481235

Facility

$140.40

Hospital Charge Code	270640541
Hospital Revenue Code	278
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$42.12
Rate for Payer: Aetna Medicare Advantage	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.80
Rate for Payer: Cigna Commercial	$70.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: Qualcare PPO/HMO/WC	$21.06

SCR PER 3.5Mx12M W2.7M23481235

Facility

$140.40

Hospital Charge Code	270640541
Hospital Revenue Code	278
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: Qualcare PPO/HMO/WC	$21.06

SCR SELF CORT 4.5/34MM48453401

Facility

$64.25

Hospital Charge Code	270605566
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$32.12
Rate for Payer: Aetna Commercial	$19.27
Rate for Payer: Aetna Medicare Advantage	$19.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.38
Rate for Payer: Cigna Commercial	$32.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.55
Rate for Payer: Qualcare PPO/HMO/WC	$9.64

SCR SELF CORT 4.5/34MM48453401

Facility

$64.25

Hospital Charge Code	270605566
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.55
Rate for Payer: Qualcare PPO/HMO/WC	$9.64

SCRUB TOP 2PK MISTY ENCORE

Facility

$26.40

Hospital Charge Code	270658930
Hospital Revenue Code	270
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$13.20
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$7.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.73
Rate for Payer: Cigna Commercial	$13.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.43
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.96
Rate for Payer: UnitedHealthcare Commercial	$13.20

SCRUB TOP 2PK MISTY ENCORE

Facility

$22.15

Hospital Charge Code	270658929
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

SCRUB TOP 2PK MISTY ENCORE

Facility

$24.85

Hospital Charge Code	270658931
Hospital Revenue Code	270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SCRUB TOP 2PK MISTY ENCORE

Facility

$22.15

Hospital Charge Code	270658929
Hospital Revenue Code	270
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$11.07
Rate for Payer: Aetna Commercial	$6.64
Rate for Payer: Aetna Medicare Advantage	$6.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.65
Rate for Payer: Cigna Commercial	$11.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.88
Rate for Payer: Oxford Commercial	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$11.07

SCRUB TOP 2PK MISTY ENCORE

Facility

$26.40

Hospital Charge Code	270658930
Hospital Revenue Code	270
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$3.96

Know your out-of-pocket cost for care.

All Charges