Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$8.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$8.24

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

SURGIPRO* 3-0 BLUE 30 SC-2

Facility

$7.45

Hospital Charge Code	270657584
Hospital Revenue Code	270
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Oxford Commercial	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.73

SURGIPRO* 3-0 BLUE 30 SC-2

Facility

$7.45

Hospital Charge Code	270657584
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$40.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

SURGIPRO II 6/0 24 IN BLUE CV

Facility

$37.54

Hospital Charge Code	270651240
Hospital Revenue Code	270
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$5.63

SURGIPRO II 6/0 24 IN BLUE CV

Facility

$37.54

Hospital Charge Code	270651240
Hospital Revenue Code	270
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$18.77
Rate for Payer: Aetna Commercial	$11.26
Rate for Payer: Aetna Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.57
Rate for Payer: Cigna Commercial	$18.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$18.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.63
Rate for Payer: UnitedHealthcare Commercial	$18.77

SURGIPRO MESH *********

Facility

$159.00

Hospital Charge Code	1605997
Hospital Revenue Code	272
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$79.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$79.50

SURGIPRO MESH *********

Facility

$159.00

Hospital Charge Code	1605997
Hospital Revenue Code	272
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

SURGIWRAP 100X30X0.02 2620201

Facility

$1,140.85

Hospital Charge Code	270634688
Hospital Revenue Code	272
Min. Negotiated Rate	$148.31
Max. Negotiated Rate	$570.42
Rate for Payer: Aetna Commercial	$342.25
Rate for Payer: Aetna Medicare Advantage	$342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.92
Rate for Payer: Cigna Commercial	$570.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.31
Rate for Payer: Oxford Commercial	$570.42
Rate for Payer: Qualcare PPO/HMO/WC	$171.13
Rate for Payer: UnitedHealthcare Commercial	$570.42

SURGIWRAP 100X30X0.02 2620201

Facility

$1,140.85

Hospital Charge Code	270634688
Hospital Revenue Code	272
Min. Negotiated Rate	$171.13
Max. Negotiated Rate	$171.13
Rate for Payer: Qualcare PPO/HMO/WC	$171.13

SURG OV EP MINIMAL VISIT 5MINS

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

SURG OV EP MINIMAL VISIT 5MINS

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$95.89
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

SURG OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$128.57
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

SURG OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$139.50
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$9.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$1,357.53
Max. Negotiated Rate	$1,357.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$800.24
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$2,715.06
Rate for Payer: Aetna Medicare Advantage	$2,715.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,307.80
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	$2,307.80
Rate for Payer: Cigna Commercial	$800.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,176.53
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

SURG TX INCOMPL ABORTION_

Facility

$24,422.22

Service Code	HCPCS 59812
Hospital Charge Code	16001013
Hospital Revenue Code	360
Min. Negotiated Rate	$3,663.33
Max. Negotiated Rate	$3,663.33
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33

SURG TX INCOMPL ABORTION_

Facility

$24,422.22

Service Code	HCPCS 59812
Hospital Charge Code	16001013
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$7,326.67
Rate for Payer: Aetna Medicare Advantage	$7,326.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,227.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,227.67
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	$6,227.67
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,174.89
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

SURG TX MISSED ABRT,1ST TMEST

Facility

$24,422.22

Service Code	HCPCS 59820
Hospital Charge Code	16001014
Hospital Revenue Code	360
Min. Negotiated Rate	$3,663.33
Max. Negotiated Rate	$3,663.33
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33

SURG TX MISSED ABRT,1ST TMEST

Facility

$24,422.22

Service Code	HCPCS 59820
Hospital Charge Code	16001014
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,708.87
Rate for Payer: Aetna Commercial	$7,326.67
Rate for Payer: Aetna Medicare Advantage	$7,326.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,227.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,227.67
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	$6,227.67
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,174.89
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

SURITAL/1GM

Facility

$28.00

Hospital Charge Code	60633941
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

Know your out-of-pocket cost for care.

All Charges