Heights University Hospital

All Charges

Charge

Type

Setting

Price

COVER LOCKING BACK UP 5-12 MM

Facility

$500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694460
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVER LOCKING BACK UP 5-12 MM

Facility

$500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694460
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVERLOC LATERAL TALUS TORNIER

Facility

$800.00

Hospital Charge Code	270339516
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVERLOC LATERAL TALUS TORNIER

Facility

$800.00

Hospital Charge Code	270339516
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVERLOC - TIBIA TORNIER

Facility

$800.00

Hospital Charge Code	270339515
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVERLOC - TIBIA TORNIER

Facility

$800.00

Hospital Charge Code	270339515
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVER MAYO TRAY STER

Facility

$18.45

Hospital Charge Code	270600165
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

COVER MAYO TRAY STER

Facility

$18.45

Hospital Charge Code	270600165
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$9.22

COVER NAVIG PROBE 5X9 3787

Facility

$47.27

Hospital Charge Code	270614504
Hospital Revenue Code	272
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$23.64
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.15
Rate for Payer: Oxford Commercial	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$23.64

COVER NAVIG PROBE 5X9 3787

Facility

$47.27

Hospital Charge Code	270614504
Hospital Revenue Code	272
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

COVER PLATE 12MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PLATE 12MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PLATE 14MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703634
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PLATE 14MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703634
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PROBE GENERAL PURPOSE

Facility

$29.08

Hospital Charge Code	270648023
Hospital Revenue Code	270
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$14.54
Rate for Payer: Aetna Commercial	$8.72
Rate for Payer: Aetna Medicare Advantage	$8.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.42
Rate for Payer: Cigna Commercial	$14.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Oxford Commercial	$14.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.36
Rate for Payer: UnitedHealthcare Commercial	$14.54

COVER PROBE GENERAL PURPOSE

Facility

$29.08

Hospital Charge Code	270648023
Hospital Revenue Code	270
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.36

COVER PROBE THERMOSCAN PRO-LT

Facility

$474.20

Hospital Charge Code	270609108
Hospital Revenue Code	271
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$237.10
Rate for Payer: Aetna Commercial	$142.26
Rate for Payer: Aetna Medicare Advantage	$142.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.92
Rate for Payer: Cigna Commercial	$237.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.65
Rate for Payer: Oxford Commercial	$237.10
Rate for Payer: Qualcare PPO/HMO/WC	$71.13
Rate for Payer: UnitedHealthcare Commercial	$237.10

COVER PROBE THERMOSCAN PRO-LT

Facility

$474.20

Hospital Charge Code	270609108
Hospital Revenue Code	271
Min. Negotiated Rate	$71.13
Max. Negotiated Rate	$71.13
Rate for Payer: Qualcare PPO/HMO/WC	$71.13

COVER SHOE DISPOSABLE

Facility

$94.80

Hospital Charge Code	270649136
Hospital Revenue Code	270
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$14.22
Rate for Payer: Qualcare PPO/HMO/WC	$14.22

COVER SHOE DISPOSABLE

Facility

$94.80

Hospital Charge Code	270649136
Hospital Revenue Code	270
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$47.40
Rate for Payer: Aetna Commercial	$28.44
Rate for Payer: Aetna Medicare Advantage	$28.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.17
Rate for Payer: Cigna Commercial	$47.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.32
Rate for Payer: Oxford Commercial	$47.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.22
Rate for Payer: UnitedHealthcare Commercial	$47.40

COVER SHOE NONCNDTVE XLG 77727

Facility

$46.30

Hospital Charge Code	270060675C
Hospital Revenue Code	272
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$23.15
Rate for Payer: Aetna Commercial	$13.89
Rate for Payer: Aetna Medicare Advantage	$13.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.81
Rate for Payer: Cigna Commercial	$23.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.02
Rate for Payer: Oxford Commercial	$23.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$23.15

COVER SHOE NONCNDTVE XLG 77727

Facility

$46.30

Hospital Charge Code	270060675C
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

COVER SITERITE

Facility

$47.50

Hospital Charge Code	270658265
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

COVER SITERITE

Facility

$47.50

Hospital Charge Code	270658265
Hospital Revenue Code	270
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$23.75

COVER SNAP KAP DOME 26 DEPTH

Facility

$7.39

Hospital Charge Code	270667869
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

Know your out-of-pocket cost for care.

All Charges