Heights University Hospital

All Charges

Charge

Type

Setting

Price

DISTAL RADIAL PLATE 3 HOLE

Facility

$8,224.30

Service Code	HCPCS C1713
Hospital Charge Code	270704349
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.64
Max. Negotiated Rate	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.64

DISTAL SPACER

Facility

$900.00

Hospital Charge Code	270656494
Hospital Revenue Code	271
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$450.00

DISTAL SPACER

Facility

$900.00

Hospital Charge Code	270656494
Hospital Revenue Code	271
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

DISTAL TIPS AMS DURA II

Facility

$2,125.00

Hospital Charge Code	270654485
Hospital Revenue Code	272
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.25
Rate for Payer: Oxford Commercial	$1,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Commercial	$1,062.50

DISTAL TIPS AMS DURA II

Facility

$2,125.00

Hospital Charge Code	270654485
Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$318.75
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

DISTAL TRIATHLON PEG

Facility

$1,057.10

Service Code	HCPCS C1776
Hospital Charge Code	270691402
Hospital Revenue Code	278
Min. Negotiated Rate	$158.56
Max. Negotiated Rate	$255.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.82
Rate for Payer: Qualcare PPO/HMO/WC	$158.56

DISTAL TRIATHLON PEG

Facility

$1,057.10

Service Code	HCPCS C1776
Hospital Charge Code	270691402
Hospital Revenue Code	278
Min. Negotiated Rate	$158.56
Max. Negotiated Rate	$528.55
Rate for Payer: Aetna Commercial	$317.13
Rate for Payer: Aetna Medicare Advantage	$317.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.56
Rate for Payer: Cigna Commercial	$528.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.82
Rate for Payer: Qualcare PPO/HMO/WC	$158.56

DISTANCE TENDON GRAFT

Facility

$30,595.00

Service Code	HCPCS 20924
Hospital Charge Code	16000796
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

DISTANCE TENDON GRAFT

Facility

$30,595.00

Service Code	HCPCS 20924
Hospital Charge Code	16000796
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$9,178.50
Rate for Payer: Aetna Medicare Advantage	$9,178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,801.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,801.73
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

DIST HUM LAT LT 11H 103MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$6,450.00
Rate for Payer: Aetna Commercial	$3,870.00
Rate for Payer: Aetna Medicare Advantage	$3,870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,289.50
Rate for Payer: Cigna Commercial	$6,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DIST HUM LAT LT 11H 103MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$3,121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DIST HUM MED LT 13H 127MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$6,450.00
Rate for Payer: Aetna Commercial	$3,870.00
Rate for Payer: Aetna Medicare Advantage	$3,870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,289.50
Rate for Payer: Cigna Commercial	$6,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DIST HUM MED LT 13H 127MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$3,121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DISTILLED WATER

Facility

$10.45

Hospital Charge Code	60628608
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

DISTILLED WATER

Facility

$10.45

Hospital Charge Code	60628608
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$56.75
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$34.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.94
Rate for Payer: Cigna Commercial	$56.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.76
Rate for Payer: Oxford Commercial	$56.75
Rate for Payer: Qualcare PPO/HMO/WC	$17.02
Rate for Payer: UnitedHealthcare Commercial	$56.75

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$17.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.02

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$173.50
Rate for Payer: Aetna Commercial	$104.10
Rate for Payer: Aetna Medicare Advantage	$104.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.48
Rate for Payer: Cigna Commercial	$173.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$52.05

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$83.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$52.05

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$592.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.75
Rate for Payer: Oxford Commercial	$987.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$987.50

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$715.65
Max. Negotiated Rate	$2,752.50
Rate for Payer: Aetna Commercial	$1,651.50
Rate for Payer: Aetna Medicare Advantage	$1,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.78
Rate for Payer: Cigna Commercial	$2,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.65
Rate for Payer: Oxford Commercial	$2,752.50
Rate for Payer: Qualcare PPO/HMO/WC	$825.75
Rate for Payer: UnitedHealthcare Commercial	$2,752.50

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$825.75
Max. Negotiated Rate	$825.75
Rate for Payer: Qualcare PPO/HMO/WC	$825.75

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
Min. Negotiated Rate	$715.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.00
Rate for Payer: Oxford Commercial	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$2,750.00

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges