Heights University Hospital

All Charges

Charge

Type

Setting

Price

SSD 1%/400GM

Facility

$87.00

Hospital Charge Code	60633918
Hospital Revenue Code	250
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

SSD 1%/50GM

Facility

$21.00

Hospital Charge Code	60633919
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

SSD 1%/50GM

Facility

$21.00

Hospital Charge Code	60633919
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.24
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$12.11
Rate for Payer: Cigna Medicare Advantage	$6.05
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.49
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.84
Rate for Payer: Wellcare Medicare Advantage	$12.11

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$12.49

SSEP (LOWER)

Facility

$711.25

Service Code	HCPCS 95926
Hospital Charge Code	5500022
Hospital Revenue Code	922
Min. Negotiated Rate	$92.46
Max. Negotiated Rate	$1,673.00
Rate for Payer: Aetna Commercial	$213.38
Rate for Payer: Aetna Medicare Advantage	$213.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.37
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.46
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.69
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

SSEP (LOWER)

Facility

$711.25

Service Code	HCPCS 95926
Hospital Charge Code	5500022
Hospital Revenue Code	922
Min. Negotiated Rate	$106.69
Max. Negotiated Rate	$106.69
Rate for Payer: Qualcare PPO/HMO/WC	$106.69

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$2,510.30
Max. Negotiated Rate	$9,655.00
Rate for Payer: Aetna Commercial	$5,793.00
Rate for Payer: Aetna Medicare Advantage	$5,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,924.05
Rate for Payer: Cigna Commercial	$9,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,510.30
Rate for Payer: Oxford Commercial	$9,655.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50
Rate for Payer: UnitedHealthcare Commercial	$9,655.00

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$2,896.50
Max. Negotiated Rate	$2,896.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50

SSEP (UPPER)

Facility

$638.45

Service Code	HCPCS 95925
Hospital Charge Code	5400106
Hospital Revenue Code	922
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

SSEP (UPPER)

Facility

$638.45

Service Code	HCPCS 95925
Hospital Charge Code	5400106
Hospital Revenue Code	922
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$1,673.00
Rate for Payer: Aetna Commercial	$191.53
Rate for Payer: Aetna Medicare Advantage	$191.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.80
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$1,673.00

S-SERIES TI CANN SRW 2.0 X11mm

Facility

$1,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270679982
Hospital Revenue Code	278
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

S-SERIES TI CANN SRW 2.0 X11mm

Facility

$1,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270679982
Hospital Revenue Code	278
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

STABILIZER G WIRE 507-114

Facility

$407.40

Hospital Charge Code	270633608
Hospital Revenue Code	278
Min. Negotiated Rate	$61.11
Max. Negotiated Rate	$203.70
Rate for Payer: Aetna Commercial	$122.22
Rate for Payer: Aetna Medicare Advantage	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.89
Rate for Payer: Cigna Commercial	$203.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.59
Rate for Payer: Qualcare PPO/HMO/WC	$61.11

STABILIZER G WIRE 507-114

Facility

$407.40

Hospital Charge Code	270633608
Hospital Revenue Code	278
Min. Negotiated Rate	$61.11
Max. Negotiated Rate	$98.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.59
Rate for Payer: Qualcare PPO/HMO/WC	$61.11

STABILIZER SDK DYNLOK 8430003

Facility

$332.00

Hospital Charge Code	270616295
Hospital Revenue Code	272
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

STABILIZER SDK DYNLOK 8430003

Facility

$332.00

Hospital Charge Code	270616295
Hospital Revenue Code	272
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$166.00
Rate for Payer: Aetna Commercial	$99.60
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$166.00

STABILIZ TIB INS TRIATHLN X3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693020
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$7,177.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

STABILIZ TIB INS TRIATHLN X3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693020
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

STAB PHLEB VEINS XTR 10-20

Facility

$25,406.80

Service Code	HCPCS 37765
Hospital Charge Code	16000739
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

STAB PHLEB VEINS XTR 10-20

Facility

$17,623.95

Service Code	HCPCS 37765
Hospital Charge Code	421037765
Hospital Revenue Code	761
Min. Negotiated Rate	$395.60
Max. Negotiated Rate	$8,811.98
Rate for Payer: Aetna Commercial	$5,287.19
Rate for Payer: Aetna Medicare Advantage	$5,287.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,494.11
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,291.11
Rate for Payer: Oxford Commercial	$8,811.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$8,811.98

STAB PHLEB VEINS XTR 10-20

Facility

$17,623.95

Service Code	HCPCS 37765
Hospital Charge Code	421037765
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

STAB PHLEB VEINS XTR 10-20

Facility

$25,406.80

Service Code	HCPCS 37765
Hospital Charge Code	16000739
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,622.04
Rate for Payer: Aetna Commercial	$7,622.04
Rate for Payer: Aetna Medicare Advantage	$7,622.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,478.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,478.73
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	$6,478.73
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,302.88
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

STAGRAFT DBM PUTTY

Facility

$7,645.00

Service Code	HCPCS C1765
Hospital Charge Code	270704573
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.75
Max. Negotiated Rate	$3,822.50
Rate for Payer: Aetna Commercial	$2,293.50
Rate for Payer: Aetna Medicare Advantage	$2,293.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,949.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,949.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,949.47
Rate for Payer: Cigna Commercial	$3,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,146.75

STAGRAFT DBM PUTTY

Facility

$7,645.00

Service Code	HCPCS C1765
Hospital Charge Code	270704573
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.75
Max. Negotiated Rate	$1,850.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,146.75

Know your out-of-pocket cost for care.

All Charges