Heights University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR COMPONENT-LEFT HIP

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270676774
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$1,682.85
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$1,530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$3,162.50
Rate for Payer: Aetna Commercial	$1,897.50
Rate for Payer: Aetna Medicare Advantage	$1,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,612.88
Rate for Payer: Cigna Commercial	$3,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

BIPOLAR DISORDERS

Facility

$7,304.21

Service Code	APR-DRG 7532
Min. Negotiated Rate	$5,217.85
Max. Negotiated Rate	$7,304.21
Rate for Payer: Aetna Better Health Medicaid	$7,160.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,304.21
Rate for Payer: Wellpoint Medicaid Managed Care	$5,217.85

BIPOLAR DISORDERS

Facility

$12,691.41

Service Code	APR-DRG 7533
Min. Negotiated Rate	$8,484.03
Max. Negotiated Rate	$12,691.41
Rate for Payer: Aetna Better Health Medicaid	$12,442.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,691.41
Rate for Payer: Wellpoint Medicaid Managed Care	$8,484.03

BIPOLAR DISORDERS

Facility

$5,413.92

Service Code	APR-DRG 7531
Min. Negotiated Rate	$3,854.70
Max. Negotiated Rate	$5,413.92
Rate for Payer: Aetna Better Health Medicaid	$5,307.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,413.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3,854.70

BIPOLAR DISORDERS

Facility

$25,217.06

Service Code	APR-DRG 7534
Min. Negotiated Rate	$17,036.54
Max. Negotiated Rate	$25,217.06
Rate for Payer: Aetna Better Health Medicaid	$24,722.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,217.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17,036.54

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$80.10
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.71
Rate for Payer: Oxford Commercial	$133.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$133.50

BIPOLAR FORCEP REPAIR

Facility

$1,750.00

Hospital Charge Code	270657273
Hospital Revenue Code	272
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$875.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$875.00

BIPOLAR FORCEP REPAIR

Facility

$1,750.00

Hospital Charge Code	270657273
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 44MM

Facility

$3,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR HEAD 44MM

Facility

$3,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: Aetna Commercial	$1,050.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00

Know your out-of-pocket cost for care.

All Charges