Heights University Hospital

All Charges

Charge

Type

Setting

Price

TLH W/T/O UTERUS OVER 250 G

Facility

$30,381.68

Service Code	HCPCS 58573
Hospital Charge Code	16000764
Hospital Revenue Code	360
Min. Negotiated Rate	$4,557.25
Max. Negotiated Rate	$4,557.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,557.25

TLIF, 10X25, L

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704015
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

TLIF, 10X25, L

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704015
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

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$5,079.00
Max. Negotiated Rate	$8,194.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$5,079.00
Max. Negotiated Rate	$16,930.00
Rate for Payer: Aetna Commercial	$10,158.00
Rate for Payer: Aetna Medicare Advantage	$10,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,634.30
Rate for Payer: Cigna Commercial	$16,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,497.69
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,497.69
Rate for Payer: Cigna Medicare Advantage	$898.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

T.L.S.O. BRACE CUSTOM

Facility

$4,798.45

Hospital Charge Code	270610014
Hospital Revenue Code	274
Min. Negotiated Rate	$719.77
Max. Negotiated Rate	$2,399.22
Rate for Payer: Aetna Commercial	$1,439.54
Rate for Payer: Aetna Medicare Advantage	$1,439.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.60
Rate for Payer: Cigna Commercial	$2,399.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.22
Rate for Payer: Qualcare PPO/HMO/WC	$719.77

T.L.S.O. BRACE CUSTOM

Facility

$4,798.45

Hospital Charge Code	270610014
Hospital Revenue Code	274
Min. Negotiated Rate	$719.77
Max. Negotiated Rate	$1,161.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.22
Rate for Payer: Qualcare PPO/HMO/WC	$719.77

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$1,358.42
Max. Negotiated Rate	$2,191.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$722.45
Max. Negotiated Rate	$2,716.84
Rate for Payer: Aetna Commercial	$2,716.84
Rate for Payer: Aetna Medicare Advantage	$2,716.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,309.32
Rate for Payer: Cigna Commercial	$1,204.08
Rate for Payer: Cigna Medicare Advantage	$722.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42

T.L.S.O. BRACE (OFF THE SHELF)

Facility

$3,981.65

Hospital Charge Code	270612938
Hospital Revenue Code	274
Min. Negotiated Rate	$597.25
Max. Negotiated Rate	$963.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.56
Rate for Payer: Qualcare PPO/HMO/WC	$597.25

T.L.S.O. BRACE (OFF THE SHELF)

Facility

$3,981.65

Hospital Charge Code	270612938
Hospital Revenue Code	274
Min. Negotiated Rate	$597.25
Max. Negotiated Rate	$1,990.83
Rate for Payer: Aetna Commercial	$1,194.49
Rate for Payer: Aetna Medicare Advantage	$1,194.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,015.32
Rate for Payer: Cigna Commercial	$1,990.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.56
Rate for Payer: Qualcare PPO/HMO/WC	$597.25

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$89.70
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$85.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$1,530.00
Rate for Payer: Aetna Better Health Medicaid	$212.34
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

TMJ - LT

Facility

$204.00

Hospital Charge Code	2009220
Hospital Revenue Code	320
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

TMJ - LT

Facility

$204.00

Hospital Charge Code	2009220
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

TMJ - RT

Facility

$204.00

Hospital Charge Code	2009225
Hospital Revenue Code	320
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

TMJ - RT

Facility

$204.00

Hospital Charge Code	2009225
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$2,598.20
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

Know your out-of-pocket cost for care.

All Charges