Heights University Hospital

All Charges

Charge

Type

Setting

Price

GMI ELISA PANEL A

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598A
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GMI ELISA PANEL B

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GMI ELISA PANEL B

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598B
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GMI ELISA PANEL C

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598C
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GMI ELISA PANEL C

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598C
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GMI ELISA PANEL D

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598D
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GMI ELISA PANEL D

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598D
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GMK FEMUR HINGE CEMENTED LEFT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687697
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$23,255.00
Rate for Payer: Aetna Commercial	$13,953.00
Rate for Payer: Aetna Medicare Advantage	$13,953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,860.05
Rate for Payer: Cigna Commercial	$23,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK FEMUR HINGE CEMENTED LEFT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687697
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$11,255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK FEMUR HINGE CEMENTED RIGHT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687951
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$23,255.00
Rate for Payer: Aetna Commercial	$13,953.00
Rate for Payer: Aetna Medicare Advantage	$13,953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,860.05
Rate for Payer: Cigna Commercial	$23,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK FEMUR HINGE CEMENTED RIGHT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687951
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$11,255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687963
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687963
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$4,471.50
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK-HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687969
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$4,471.50
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK-HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687969
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK STEM EXTEN 11mmx30mm

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679835
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

GMK STEM EXTEN 11mmx30mm

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679835
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$825.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

GMK TIBIAL TRAY HINGE LEFT S2

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687684
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$5,891.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

GMK TIBIAL TRAY HINGE LEFT S2

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687684
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$12,172.50
Rate for Payer: Aetna Commercial	$7,303.50
Rate for Payer: Aetna Medicare Advantage	$7,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,207.98
Rate for Payer: Cigna Commercial	$12,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

GNS II CMT TIB SIZE 3 RIGHT

Facility

$15,872.50

Service Code	HCPCS C1776
Hospital Charge Code	270686902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,380.88
Max. Negotiated Rate	$3,841.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,174.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,841.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.88

GNS II CMT TIB SIZE 3 RIGHT

Facility

$15,872.50

Service Code	HCPCS C1776
Hospital Charge Code	270686902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,380.88
Max. Negotiated Rate	$7,936.25
Rate for Payer: Aetna Commercial	$4,761.75
Rate for Payer: Aetna Medicare Advantage	$4,761.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,047.49
Rate for Payer: Cigna Commercial	$7,936.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,841.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.88

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$4,878.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$10,080.00
Rate for Payer: Aetna Commercial	$6,048.00
Rate for Payer: Aetna Medicare Advantage	$6,048.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,140.80
Rate for Payer: Cigna Commercial	$10,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.38
Max. Negotiated Rate	$1,622.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.38
Max. Negotiated Rate	$3,351.25
Rate for Payer: Aetna Commercial	$2,010.75
Rate for Payer: Aetna Medicare Advantage	$2,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.14
Rate for Payer: Cigna Commercial	$3,351.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38

Know your out-of-pocket cost for care.

All Charges