Heights University Hospital

All Charges

Charge

Type

Setting

Price

WALLFLEXFC18/23-25x12 Eso 5612

Facility

$12,375.00

Hospital Charge Code	270643743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.25
Max. Negotiated Rate	$6,187.50
Rate for Payer: Aetna Commercial	$3,712.50
Rate for Payer: Aetna Medicare Advantage	$3,712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,155.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,155.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,155.62
Rate for Payer: Cigna Commercial	$6,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,994.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.25

WALLFLEXFC18/23-25x12 Eso 5612

Facility

$12,375.00

Hospital Charge Code	270643743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.25
Max. Negotiated Rate	$2,994.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,994.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.25

WALLGRAFT 10x50 ENDOPROST 7050

Facility

$9,672.00

Hospital Charge Code	270623518V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$2,340.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

WALLGRAFT 10x50 ENDOPROST 7050

Facility

$9,672.00

Hospital Charge Code	270623518V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$4,836.00
Rate for Payer: Aetna Commercial	$2,901.60
Rate for Payer: Aetna Medicare Advantage	$2,901.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.36
Rate for Payer: Cigna Commercial	$4,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

WALLGRAFT 10x50 ENDOPROST 7050

Facility

$10,675.00

Hospital Charge Code	270623517V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$3,202.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

WALLGRAFT 10x50 ENDOPROST 7050

Facility

$10,675.00

Hospital Charge Code	270623517V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

WALLGRAFT 14 X 50 70545

Facility

$9,672.00

Hospital Charge Code	270632221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$2,340.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

WALLGRAFT 14 X 50 70545

Facility

$9,672.00

Hospital Charge Code	270632221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$4,836.00
Rate for Payer: Aetna Commercial	$2,901.60
Rate for Payer: Aetna Medicare Advantage	$2,901.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.36
Rate for Payer: Cigna Commercial	$4,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

WALLGRAFT 14 X 70 70547

Facility

$11,036.00

Hospital Charge Code	270632222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$5,518.00
Rate for Payer: Aetna Commercial	$3,310.80
Rate for Payer: Aetna Medicare Advantage	$3,310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,814.18
Rate for Payer: Cigna Commercial	$5,518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

WALLGRAFT 14 X 70 70547

Facility

$11,036.00

Hospital Charge Code	270632222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$2,670.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

WALLGRAFT 8x50 ENDOPROST 70585

Facility

$9,750.00

Hospital Charge Code	270623516V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

WALLGRAFT 8x50 ENDOPROST 70585

Facility

$9,750.00

Hospital Charge Code	270623516V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$2,925.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

WALL HIGH G7 LONGEVITY 36MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692343
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

WALL HIGH G7 LONGEVITY 36MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692343
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

WALL MAXILLO FACIAL FRACTURE

Facility

$54.00

Hospital Charge Code	270332245
Hospital Revenue Code	278
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

WALL MAXILLO FACIAL FRACTURE

Facility

$54.00

Hospital Charge Code	270332245
Hospital Revenue Code	278
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

WALLSTENT 10FR 14x60mm 100cm

Facility

$5,250.00

Hospital Charge Code	270626883
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 10FR 14x60mm 100cm

Facility

$5,250.00

Hospital Charge Code	270626883
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 10FR 22X90MM 230CM

Facility

$8,625.00

Hospital Charge Code	270629357
Hospital Revenue Code	278
Min. Negotiated Rate	$1,293.75
Max. Negotiated Rate	$4,312.50
Rate for Payer: Aetna Commercial	$2,587.50
Rate for Payer: Aetna Medicare Advantage	$2,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,199.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,199.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,199.38
Rate for Payer: Cigna Commercial	$4,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,087.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,293.75

WALLSTENT 10FR 22X90MM 230CM

Facility

$8,625.00

Hospital Charge Code	270629357
Hospital Revenue Code	278
Min. Negotiated Rate	$1,293.75
Max. Negotiated Rate	$2,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,087.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,293.75

WALLSTENT 11FR 18x60mm 75cm

Facility

$6,800.65

Service Code	HCPCS C1876
Hospital Charge Code	270636322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.10
Max. Negotiated Rate	$3,400.32
Rate for Payer: Aetna Commercial	$2,040.19
Rate for Payer: Aetna Medicare Advantage	$2,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.17
Rate for Payer: Cigna Commercial	$3,400.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,645.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.10

WALLSTENT 11FR 18x60mm 75cm

Facility

$6,800.65

Service Code	HCPCS C1876
Hospital Charge Code	270636322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.10
Max. Negotiated Rate	$1,645.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,645.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.10

WALLSTENT 12/60 8FR 75cm 40212

Facility

$5,401.15

Hospital Charge Code	270626882V
Hospital Revenue Code	278
Min. Negotiated Rate	$810.17
Max. Negotiated Rate	$1,307.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,307.08
Rate for Payer: Qualcare PPO/HMO/WC	$810.17

WALLSTENT 12/60 8FR 75cm 40212

Facility

$5,401.15

Hospital Charge Code	270626882V
Hospital Revenue Code	278
Min. Negotiated Rate	$810.17
Max. Negotiated Rate	$2,700.57
Rate for Payer: Aetna Commercial	$1,620.35
Rate for Payer: Aetna Medicare Advantage	$1,620.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.29
Rate for Payer: Cigna Commercial	$2,700.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,307.08
Rate for Payer: Qualcare PPO/HMO/WC	$810.17

WALLSTENT 12/60 9FR 100cm

Facility

$5,250.00

Hospital Charge Code	270626882
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

Know your out-of-pocket cost for care.

All Charges