Heights University Hospital

All Charges

Charge

Type

Setting

Price

CUP M2A MAGNUM 54x48 US157854

Facility

$16,195.00

Hospital Charge Code	270635322
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$3,919.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

CUP M2A MAGNUM PF 52x46mm

Facility

$18,555.00

Hospital Charge Code	270642989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.25
Max. Negotiated Rate	$4,490.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25

CUP M2A MAGNUM PF 52x46mm

Facility

$18,555.00

Hospital Charge Code	270642989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.25
Max. Negotiated Rate	$9,277.50
Rate for Payer: Aetna Commercial	$5,566.50
Rate for Payer: Aetna Medicare Advantage	$5,566.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,731.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,731.52
Rate for Payer: Cigna Commercial	$9,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,490.31
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.25

CUP M2A MAGNUM PF 56mmX50mm

Facility

$16,065.50

Hospital Charge Code	270636167
Hospital Revenue Code	278
Min. Negotiated Rate	$2,409.82
Max. Negotiated Rate	$8,032.75
Rate for Payer: Aetna Commercial	$4,819.65
Rate for Payer: Aetna Medicare Advantage	$4,819.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,096.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,096.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,213.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,096.70
Rate for Payer: Cigna Commercial	$8,032.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,887.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.82

CUP M2A MAGNUM PF 56mmX50mm

Facility

$16,065.50

Hospital Charge Code	270636167
Hospital Revenue Code	278
Min. Negotiated Rate	$2,409.82
Max. Negotiated Rate	$3,887.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,213.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,887.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,409.82

CUP M2A MAG PF 58x52 US157858

Facility

$6,110.00

Hospital Charge Code	270638449
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$3,055.00
Rate for Payer: Aetna Commercial	$1,833.00
Rate for Payer: Aetna Medicare Advantage	$1,833.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,558.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,558.05
Rate for Payer: Cigna Commercial	$3,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

CUP M2A MAG PF 58x52 US157858

Facility

$6,110.00

Hospital Charge Code	270638449
Hospital Revenue Code	278
Min. Negotiated Rate	$916.50
Max. Negotiated Rate	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,478.62
Rate for Payer: Qualcare PPO/HMO/WC	$916.50

CUP MEDICINE 1 OZ

Facility

$4.00

Hospital Charge Code	270300770
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

CUP MEDICINE 1 OZ

Facility

$4.00

Hospital Charge Code	270300770
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CUP MOD TM CLUS 48mm6202-48-22

Facility

$9,392.50

Hospital Charge Code	270635054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.88
Max. Negotiated Rate	$4,696.25
Rate for Payer: Aetna Commercial	$2,817.75
Rate for Payer: Aetna Medicare Advantage	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.09
Rate for Payer: Cigna Commercial	$4,696.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.88

CUP MOD TM CLUS 48mm6202-48-22

Facility

$9,392.50

Hospital Charge Code	270635054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.88
Max. Negotiated Rate	$2,272.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,878.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,272.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,408.88

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$668.25
Max. Negotiated Rate	$2,227.50
Rate for Payer: Aetna Commercial	$1,336.50
Rate for Payer: Aetna Medicare Advantage	$1,336.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.03
Rate for Payer: Cigna Commercial	$2,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: Qualcare PPO/HMO/WC	$668.25

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$668.25
Max. Negotiated Rate	$1,078.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: Qualcare PPO/HMO/WC	$668.25

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$1,866.46
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

CUP MODU TM CLUS 48m 062024820

Facility

$12,377.80

Hospital Charge Code	270637224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.67
Max. Negotiated Rate	$2,995.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,995.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.67

CUP MODU TM CLUS 48m 062024820

Facility

$12,377.80

Hospital Charge Code	270637224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,856.67
Max. Negotiated Rate	$6,188.90
Rate for Payer: Aetna Commercial	$3,713.34
Rate for Payer: Aetna Medicare Advantage	$3,713.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,156.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,156.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,475.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,156.34
Rate for Payer: Cigna Commercial	$6,188.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,995.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,856.67

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
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

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
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

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$2,677.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$2,677.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

Know your out-of-pocket cost for care.

All Charges