Heights University Hospital

All Charges

Charge

Type

Setting

Price

ACID PHOSPHATASE, TOTAL

Facility

$67.25

Service Code	HCPCS 84060
Hospital Charge Code	3000106
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

ACID PHOSPHATASE, TOTAL

Facility

$67.25

Service Code	HCPCS 84060
Hospital Charge Code	3000106
Hospital Revenue Code	301
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$7.64
Rate for Payer: Cigna Medicare Advantage	$3.82
Rate for Payer: Clover Medicare Advantage	$7.26
Rate for Payer: EmblemHealth Commercial	$22.92
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.10
Rate for Payer: Wellcare Medicare Advantage	$7.64

ACID PHOSPHATASE,TOTAL

Facility

$203.00

Service Code	HCPCS 84060
Hospital Charge Code	38472032
Hospital Revenue Code	301
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

ACID PHOSPHATASE,TOTAL

Facility

$203.00

Service Code	HCPCS 84060
Hospital Charge Code	38472032
Hospital Revenue Code	301
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$7.64
Rate for Payer: Cigna Medicare Advantage	$3.82
Rate for Payer: Clover Medicare Advantage	$7.26
Rate for Payer: EmblemHealth Commercial	$22.92
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$8.10
Rate for Payer: Wellcare Medicare Advantage	$7.64

ACIS SPACER 7MM 16X14

Facility

$9,080.00

Service Code	HCPCS C1765
Hospital Charge Code	270705056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$4,540.00
Rate for Payer: Aetna Commercial	$2,724.00
Rate for Payer: Aetna Medicare Advantage	$2,724.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,315.40
Rate for Payer: Cigna Commercial	$4,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

ACIS SPACER 7MM 16X14

Facility

$9,080.00

Service Code	HCPCS C1765
Hospital Charge Code	270705056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$2,197.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

ACL DISP KIT

Facility

$3,165.00

Hospital Charge Code	270678191
Hospital Revenue Code	272
Min. Negotiated Rate	$411.45
Max. Negotiated Rate	$1,582.50
Rate for Payer: Aetna Commercial	$949.50
Rate for Payer: Aetna Medicare Advantage	$949.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.08
Rate for Payer: Cigna Commercial	$1,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.45
Rate for Payer: Oxford Commercial	$1,582.50
Rate for Payer: Qualcare PPO/HMO/WC	$474.75
Rate for Payer: UnitedHealthcare Commercial	$1,582.50

ACL DISP KIT

Facility

$3,165.00

Hospital Charge Code	270678191
Hospital Revenue Code	272
Min. Negotiated Rate	$474.75
Max. Negotiated Rate	$474.75
Rate for Payer: Qualcare PPO/HMO/WC	$474.75

ACL DISPOSABLE PACK

Facility

$2,470.00

Hospital Charge Code	270670502
Hospital Revenue Code	272
Min. Negotiated Rate	$370.50
Max. Negotiated Rate	$370.50
Rate for Payer: Qualcare PPO/HMO/WC	$370.50

ACL DISPOSABLE PACK

Facility

$2,470.00

Hospital Charge Code	270670502
Hospital Revenue Code	272
Min. Negotiated Rate	$321.10
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$741.00
Rate for Payer: Aetna Medicare Advantage	$741.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$629.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$629.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$629.85
Rate for Payer: Cigna Commercial	$1,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.10
Rate for Payer: Oxford Commercial	$1,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$370.50
Rate for Payer: UnitedHealthcare Commercial	$1,235.00

ACL DISP PACK BONE-TENDON-BONE

Facility

$1,482.00

Hospital Charge Code	270675672
Hospital Revenue Code	272
Min. Negotiated Rate	$192.66
Max. Negotiated Rate	$741.00
Rate for Payer: Aetna Commercial	$444.60
Rate for Payer: Aetna Medicare Advantage	$444.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.91
Rate for Payer: Cigna Commercial	$741.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.66
Rate for Payer: Oxford Commercial	$741.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.30
Rate for Payer: UnitedHealthcare Commercial	$741.00

ACL DISP PACK BONE-TENDON-BONE

Facility

$1,482.00

Hospital Charge Code	270675672
Hospital Revenue Code	272
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$222.30
Rate for Payer: Qualcare PPO/HMO/WC	$222.30

ACL GRAFTLINK

Facility

$10,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270667100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,629.75
Max. Negotiated Rate	$2,629.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,173.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,629.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,629.75

ACL GRAFTLINK

Facility

$10,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270667100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,629.75
Max. Negotiated Rate	$5,432.50
Rate for Payer: Aetna Commercial	$3,259.50
Rate for Payer: Aetna Medicare Advantage	$3,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,770.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,770.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,770.57
Rate for Payer: Cigna Commercial	$5,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,629.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,629.75

ACL INSTRUMENTATION SYSTEM

Facility

$1,250.00

Hospital Charge Code	270675673
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

ACL INSTRUMENTATION SYSTEM

Facility

$1,250.00

Hospital Charge Code	270675673
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ACL INST SYSTEM USAGE

Facility

$2,500.00

Hospital Charge Code	270670503
Hospital Revenue Code	272
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$1,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$1,250.00

ACL INST SYSTEM USAGE

Facility

$2,500.00

Hospital Charge Code	270670503
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

ACL KIT

Facility

$1,240.00

Hospital Charge Code	270620357
Hospital Revenue Code	272
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00

ACL KIT

Facility

$1,240.00

Hospital Charge Code	270620357
Hospital Revenue Code	272
Min. Negotiated Rate	$161.20
Max. Negotiated Rate	$620.00
Rate for Payer: Aetna Commercial	$372.00
Rate for Payer: Aetna Medicare Advantage	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.20
Rate for Payer: Cigna Commercial	$620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.20
Rate for Payer: Oxford Commercial	$620.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00
Rate for Payer: UnitedHealthcare Commercial	$620.00

ACL KIT DISP

Facility

$2,730.00

Hospital Charge Code	270635264
Hospital Revenue Code	272
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$1,365.00
Rate for Payer: Aetna Commercial	$819.00
Rate for Payer: Aetna Medicare Advantage	$819.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.15
Rate for Payer: Cigna Commercial	$1,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.90
Rate for Payer: Oxford Commercial	$1,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$409.50
Rate for Payer: UnitedHealthcare Commercial	$1,365.00

ACL KIT DISP

Facility

$2,730.00

Hospital Charge Code	270635264
Hospital Revenue Code	272
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$409.50
Rate for Payer: Qualcare PPO/HMO/WC	$409.50

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632390
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632391
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632391
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

Know your out-of-pocket cost for care.

All Charges