Heights University Hospital

All Charges

Charge

Type

Setting

Price

SECURED LUM ANT CAGE SMALL H12

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705124
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURED LUM ANT CAGE SMALL H12

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705124
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURED LUMBAR ANTERIOR CAGE M

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704527
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$7,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURED LUMBAR ANTERIOR CAGE M

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704527
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

SECURE STRAP 5MM

Facility

$862.50

Hospital Charge Code	270339466
Hospital Revenue Code	272
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$129.38
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

SECURE STRAP 5MM

Facility

$862.50

Hospital Charge Code	270339466
Hospital Revenue Code	272
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$431.25
Rate for Payer: Aetna Commercial	$258.75
Rate for Payer: Aetna Medicare Advantage	$258.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.94
Rate for Payer: Cigna Commercial	$431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.12
Rate for Payer: Oxford Commercial	$431.25
Rate for Payer: Qualcare PPO/HMO/WC	$129.38
Rate for Payer: UnitedHealthcare Commercial	$431.25

SECUR-FIT MAX 132 HIP SYSTEM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270692858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.41
Max. Negotiated Rate	$2,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41

SECUR-FIT MAX 132 HIP SYSTEM

Facility

$11,449.40

Service Code	HCPCS C1776
Hospital Charge Code	270692858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.41
Max. Negotiated Rate	$5,724.70
Rate for Payer: Aetna Commercial	$3,434.82
Rate for Payer: Aetna Medicare Advantage	$3,434.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,289.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.60
Rate for Payer: Cigna Commercial	$5,724.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.41

SECUR-IT FOR PAS PMV SECURE-IT

Facility

$6.00

Hospital Charge Code	270637550
Hospital Revenue Code	272
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SECUR-IT FOR PAS PMV SECURE-IT

Facility

$6.00

Hospital Charge Code	270637550
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SEDIMENTATION RATE (ESR)

Facility

$667.59

Service Code	HCPCS 85651
Hospital Charge Code	3006087
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SEDIMENTATION RATE (ESR)

Facility

$667.59

Service Code	HCPCS 85651
Hospital Charge Code	3006087
Hospital Revenue Code	305
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.65
Rate for Payer: Cigna Commercial	$4.27
Rate for Payer: Cigna Medicare Advantage	$2.13
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
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	$4.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.53
Rate for Payer: Wellcare Medicare Advantage	$4.27

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.83
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.65
Rate for Payer: Cigna Commercial	$4.27
Rate for Payer: Cigna Medicare Advantage	$2.13
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.53
Rate for Payer: Wellcare Medicare Advantage	$4.27

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$8.75
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.89
Rate for Payer: Cigna Commercial	$2.70
Rate for Payer: Cigna Medicare Advantage	$1.35
Rate for Payer: Clover Medicare Advantage	$2.56
Rate for Payer: EmblemHealth Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$2.86
Rate for Payer: Wellcare Medicare Advantage	$2.70

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SEED IMPLANT

Facility

$62.50

Hospital Charge Code	270613879
Hospital Revenue Code	270
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$18.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.12
Rate for Payer: Oxford Commercial	$31.25
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$31.25

SEED IMPLANT

Facility

$62.50

Hospital Charge Code	270613879
Hospital Revenue Code	270
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

SEED IMPLANT IBT IS-12501

Facility

$178.45

Hospital Charge Code	270617741
Hospital Revenue Code	272
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$89.22
Rate for Payer: Aetna Commercial	$53.53
Rate for Payer: Aetna Medicare Advantage	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.50
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.20
Rate for Payer: Oxford Commercial	$89.22
Rate for Payer: Qualcare PPO/HMO/WC	$26.77
Rate for Payer: UnitedHealthcare Commercial	$89.22

SEED IMPLANT IBT IS-12501

Facility

$178.45

Hospital Charge Code	270617741
Hospital Revenue Code	272
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$26.77
Rate for Payer: Qualcare PPO/HMO/WC	$26.77

SEED PALLADIUM 103K 200LINK

Facility

$361.25

Hospital Charge Code	270646147
Hospital Revenue Code	278
Min. Negotiated Rate	$54.19
Max. Negotiated Rate	$180.62
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna Medicare Advantage	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.12
Rate for Payer: Cigna Commercial	$180.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.42
Rate for Payer: Qualcare PPO/HMO/WC	$54.19

SEED PALLADIUM 103K 200LINK

Facility

$361.25

Hospital Charge Code	270646147
Hospital Revenue Code	278
Min. Negotiated Rate	$54.19
Max. Negotiated Rate	$87.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.42
Rate for Payer: Qualcare PPO/HMO/WC	$54.19

SEEDS IODINE PRELOADED I125

Facility

$75.00

Hospital Charge Code	270636489
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SEEDS IODINE PRELOADED I125

Facility

$75.00

Hospital Charge Code	270636489
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$9,031.50
Max. Negotiated Rate	$14,570.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50

Know your out-of-pocket cost for care.

All Charges