Heights University Hospital

All Charges

Charge

Type

Setting

Price

BUR LEGEND 10CM 6MM MIDAS REX

Facility

$731.50

Hospital Charge Code	270660510
Hospital Revenue Code	272
Min. Negotiated Rate	$95.09
Max. Negotiated Rate	$365.75
Rate for Payer: UnitedHealthcare Commercial	$365.75
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare Advantage	$219.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.53
Rate for Payer: Cigna Commercial	$365.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.09
Rate for Payer: Oxford Commercial	$365.75
Rate for Payer: Qualcare PPO/HMO/WC	$109.72

BUR LEGEND 10CM 6MM MIDAS REX

Facility

$731.50

Hospital Charge Code	270660510
Hospital Revenue Code	272
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$109.72
Rate for Payer: Qualcare PPO/HMO/WC	$109.72

BUR LVT CRB RND 1 48 5056164

Facility

$492.85

Hospital Charge Code	270622541
Hospital Revenue Code	272
Min. Negotiated Rate	$64.07
Max. Negotiated Rate	$246.43
Rate for Payer: Aetna Commercial	$147.85
Rate for Payer: Aetna Medicare Advantage	$147.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.68
Rate for Payer: Cigna Commercial	$246.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.07
Rate for Payer: Oxford Commercial	$246.43
Rate for Payer: Qualcare PPO/HMO/WC	$73.93
Rate for Payer: UnitedHealthcare Commercial	$246.43

BUR LVT CRB RND 1 48 5056164

Facility

$492.85

Hospital Charge Code	270622541
Hospital Revenue Code	272
Min. Negotiated Rate	$73.93
Max. Negotiated Rate	$73.93
Rate for Payer: Qualcare PPO/HMO/WC	$73.93

BUR LVT CRB RND 2.5 48 5056149

Facility

$520.00

Hospital Charge Code	270622537
Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

BUR LVT CRB RND 2.5 48 5056149

Facility

$520.00

Hospital Charge Code	270622537
Hospital Revenue Code	272
Min. Negotiated Rate	$67.60
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$260.00

BUR LVT CRB RND 3 30 5056116

Facility

$520.00

Hospital Charge Code	270621859
Hospital Revenue Code	272
Min. Negotiated Rate	$67.60
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$260.00

BUR LVT CRB RND 3 30 5056116

Facility

$520.00

Hospital Charge Code	270621859
Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

BUR LVT CRB RND 4 30 5056119

Facility

$495.00

Hospital Charge Code	270622535
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BUR LVT CRB RND 4 30 5056119

Facility

$495.00

Hospital Charge Code	270622535
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

BUR LVT CRB RND 5 30 5056118

Facility

$423.70

Hospital Charge Code	270621858
Hospital Revenue Code	272
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$211.85
Rate for Payer: Aetna Commercial	$127.11
Rate for Payer: Aetna Medicare Advantage	$127.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.04
Rate for Payer: Cigna Commercial	$211.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.08
Rate for Payer: Oxford Commercial	$211.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.55
Rate for Payer: UnitedHealthcare Commercial	$211.85

BUR LVT CRB RND 5 30 5056118

Facility

$423.70

Hospital Charge Code	270621858
Hospital Revenue Code	272
Min. Negotiated Rate	$63.55
Max. Negotiated Rate	$63.55
Rate for Payer: Qualcare PPO/HMO/WC	$63.55

BUR LVT CRB RND 6.5 30 5056117

Facility

$495.00

Hospital Charge Code	270622534
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BUR LVT CRB RND 6.5 30 5056117

Facility

$495.00

Hospital Charge Code	270622534
Hospital Revenue Code	272
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$148.50
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.35
Rate for Payer: Oxford Commercial	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$247.50

BUR LVT DMD RND 2 48 5056162

Facility

$567.25

Hospital Charge Code	270621860
Hospital Revenue Code	272
Min. Negotiated Rate	$73.74
Max. Negotiated Rate	$283.62
Rate for Payer: Aetna Commercial	$170.18
Rate for Payer: Aetna Medicare Advantage	$170.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.65
Rate for Payer: Cigna Commercial	$283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.74
Rate for Payer: Oxford Commercial	$283.62
Rate for Payer: Qualcare PPO/HMO/WC	$85.09
Rate for Payer: UnitedHealthcare Commercial	$283.62

BUR LVT DMD RND 2 48 5056162

Facility

$567.25

Hospital Charge Code	270621860
Hospital Revenue Code	272
Min. Negotiated Rate	$85.09
Max. Negotiated Rate	$85.09
Rate for Payer: Qualcare PPO/HMO/WC	$85.09

BUR LVT DMD RND 3 48 5056159

Facility

$566.45

Hospital Charge Code	270622540
Hospital Revenue Code	272
Min. Negotiated Rate	$84.97
Max. Negotiated Rate	$84.97
Rate for Payer: Qualcare PPO/HMO/WC	$84.97

BUR LVT DMD RND 3 48 5056159

Facility

$566.45

Hospital Charge Code	270622540
Hospital Revenue Code	272
Min. Negotiated Rate	$73.64
Max. Negotiated Rate	$283.23
Rate for Payer: Aetna Commercial	$169.94
Rate for Payer: Aetna Medicare Advantage	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.44
Rate for Payer: Cigna Commercial	$283.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.64
Rate for Payer: Oxford Commercial	$283.23
Rate for Payer: Qualcare PPO/HMO/WC	$84.97
Rate for Payer: UnitedHealthcare Commercial	$283.23

BUR LVT DMD RND 4 38 5056148

Facility

$565.00

Hospital Charge Code	270622538
Hospital Revenue Code	272
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$84.75
Rate for Payer: Qualcare PPO/HMO/WC	$84.75

BUR LVT DMD RND 4 38 5056148

Facility

$565.00

Hospital Charge Code	270622538
Hospital Revenue Code	272
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$282.50
Rate for Payer: Aetna Commercial	$169.50
Rate for Payer: Aetna Medicare Advantage	$169.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.07
Rate for Payer: Cigna Commercial	$282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.45
Rate for Payer: Oxford Commercial	$282.50
Rate for Payer: Qualcare PPO/HMO/WC	$84.75
Rate for Payer: UnitedHealthcare Commercial	$282.50

BUR LVT DMD RND 4 48 5056146

Facility

$519.25

Hospital Charge Code	270622536
Hospital Revenue Code	272
Min. Negotiated Rate	$77.89
Max. Negotiated Rate	$77.89
Rate for Payer: Qualcare PPO/HMO/WC	$77.89

BUR LVT DMD RND 4 48 5056146

Facility

$519.25

Hospital Charge Code	270622536
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$259.62
Rate for Payer: Aetna Commercial	$155.78
Rate for Payer: Aetna Medicare Advantage	$155.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.41
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$259.62
Rate for Payer: Qualcare PPO/HMO/WC	$77.89
Rate for Payer: UnitedHealthcare Commercial	$259.62

BUR LVT DMD RND 5 48 5056150

Facility

$567.25

Hospital Charge Code	270621861
Hospital Revenue Code	272
Min. Negotiated Rate	$85.09
Max. Negotiated Rate	$85.09
Rate for Payer: Qualcare PPO/HMO/WC	$85.09

BUR LVT DMD RND 5 48 5056150

Facility

$567.25

Hospital Charge Code	270621861
Hospital Revenue Code	272
Min. Negotiated Rate	$73.74
Max. Negotiated Rate	$283.62
Rate for Payer: Aetna Commercial	$170.18
Rate for Payer: Aetna Medicare Advantage	$170.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.65
Rate for Payer: Cigna Commercial	$283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.74
Rate for Payer: Oxford Commercial	$283.62
Rate for Payer: Qualcare PPO/HMO/WC	$85.09
Rate for Payer: UnitedHealthcare Commercial	$283.62

BUR LVT UP RD DIAM 4 702134

Facility

$518.45

Hospital Charge Code	270629149
Hospital Revenue Code	272
Min. Negotiated Rate	$67.40
Max. Negotiated Rate	$259.23
Rate for Payer: Aetna Commercial	$155.53
Rate for Payer: Aetna Medicare Advantage	$155.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.20
Rate for Payer: Cigna Commercial	$259.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.40
Rate for Payer: Oxford Commercial	$259.23
Rate for Payer: Qualcare PPO/HMO/WC	$77.77
Rate for Payer: UnitedHealthcare Commercial	$259.23

Know your out-of-pocket cost for care.

All Charges