Heights University Hospital

All Charges

Charge

Type

Setting

Price

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.90

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.58
Rate for Payer: Oxford Commercial	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$183.00

TA 30 3.5/4.8 LOAD UNIT *****

Facility

$131.00

Hospital Charge Code	1601004
Hospital Revenue Code	272
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

TA 30 3.5/4.8 LOAD UNIT *****

Facility

$131.00

Hospital Charge Code	1601004
Hospital Revenue Code	272
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$65.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$65.50

TA 30 3.5 MULTIF STAPLE *****

Facility

$491.00

Hospital Charge Code	1600980
Hospital Revenue Code	272
Min. Negotiated Rate	$63.83
Max. Negotiated Rate	$245.50
Rate for Payer: Aetna Commercial	$147.30
Rate for Payer: Aetna Medicare Advantage	$147.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.20
Rate for Payer: Cigna Commercial	$245.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.83
Rate for Payer: Oxford Commercial	$245.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.65
Rate for Payer: UnitedHealthcare Commercial	$245.50

TA 30 3.5 MULTIF STAPLE *****

Facility

$491.00

Hospital Charge Code	1600980
Hospital Revenue Code	272
Min. Negotiated Rate	$73.65
Max. Negotiated Rate	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$73.65

TA 55 3.5/4.8 LOAD UNIT *****

Facility

$140.00

Hospital Charge Code	1601012
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TA 55 3.5/4.8 LOAD UNIT *****

Facility

$140.00

Hospital Charge Code	1601012
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$70.00

TA 55 3.5 MULTIF STAPLE ******

Facility

$505.00

Hospital Charge Code	1600998
Hospital Revenue Code	272
Min. Negotiated Rate	$65.65
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.65
Rate for Payer: Oxford Commercial	$252.50
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$252.50

TA 55 3.5 MULTIF STAPLE ******

Facility

$505.00

Hospital Charge Code	1600998
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TA 90 LONG 3.5 4.8 *****

Facility

$301.00

Hospital Charge Code	1600949
Hospital Revenue Code	272
Min. Negotiated Rate	$39.13
Max. Negotiated Rate	$150.50
Rate for Payer: Aetna Commercial	$90.30
Rate for Payer: Aetna Medicare Advantage	$90.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.75
Rate for Payer: Cigna Commercial	$150.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.13
Rate for Payer: Oxford Commercial	$150.50
Rate for Payer: Qualcare PPO/HMO/WC	$45.15
Rate for Payer: UnitedHealthcare Commercial	$150.50

TA 90 LONG 3.5 4.8 *****

Facility

$301.00

Hospital Charge Code	1600949
Hospital Revenue Code	272
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Qualcare PPO/HMO/WC	$45.15

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,895.42
Rate for Payer: Aetna Commercial	$6,819.61
Rate for Payer: Aetna Medicare Advantage	$6,819.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,796.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,796.67
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	$5,796.67
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,955.17
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.81
Max. Negotiated Rate	$3,409.81
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81

TA ARTHRODESIS P/PL- 1L,BLW C2

Facility

$40,491.68

Service Code	HCPCS 22600
Hospital Charge Code	16000673
Hospital Revenue Code	360
Min. Negotiated Rate	$6,073.75
Max. Negotiated Rate	$6,073.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75

TA ARTHRODESIS P/PL- 1L,BLW C2

Facility

$40,491.68

Service Code	HCPCS 22600
Hospital Charge Code	16000673
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$41,754.94
Rate for Payer: Aetna Commercial	$12,147.50
Rate for Payer: Aetna Medicare Advantage	$12,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,325.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,325.38
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	$10,325.38
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,263.92
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

TA ARTIFIC DISC ADDL

Facility

$47,548.90

Service Code	HCPCS 22857
Hospital Charge Code	1600000870
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$41,754.94
Rate for Payer: Aetna Commercial	$14,264.67
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
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	$12,124.97
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,181.36
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$10,997.00

TA ARTIFIC DISC ADDL

Facility

$47,548.90

Service Code	HCPCS 22857
Hospital Charge Code	1600000870
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

TAB ELECTRODE ADAPTOR TO LEAD

Facility

$9.00

Hospital Charge Code	270616942
Hospital Revenue Code	270
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

TAB ELECTRODE ADAPTOR TO LEAD

Facility

$9.00

Hospital Charge Code	270616942
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TAB EXTENSION

Facility

$1,187.50

Service Code	HCPCS C1713
Hospital Charge Code	270705517
Hospital Revenue Code	278
Min. Negotiated Rate	$178.12
Max. Negotiated Rate	$287.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.38
Rate for Payer: Qualcare PPO/HMO/WC	$178.12

TAB EXTENSION

Facility

$1,187.50

Service Code	HCPCS C1713
Hospital Charge Code	270705517
Hospital Revenue Code	278
Min. Negotiated Rate	$178.12
Max. Negotiated Rate	$593.75
Rate for Payer: Aetna Commercial	$356.25
Rate for Payer: Aetna Medicare Advantage	$356.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.81
Rate for Payer: Cigna Commercial	$593.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.38
Rate for Payer: Qualcare PPO/HMO/WC	$178.12

TACE/25MG/CAP

Facility

$8.00

Hospital Charge Code	60633950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

TACE/25MG/CAP

Facility

$8.00

Hospital Charge Code	60633950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

Know your out-of-pocket cost for care.

All Charges