Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMMOBILIZER KNEE ONE SIZE 20

Facility

$89.75

Hospital Charge Code	270302815
Hospital Revenue Code	272
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$44.88
Rate for Payer: Aetna Commercial	$26.93
Rate for Payer: Aetna Medicare Advantage	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.89
Rate for Payer: Cigna Commercial	$44.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.67
Rate for Payer: Oxford Commercial	$44.88
Rate for Payer: Qualcare PPO/HMO/WC	$13.46
Rate for Payer: UnitedHealthcare Commercial	$44.88

IMMOBILIZER KNEE SM

Facility

$127.25

Hospital Charge Code	270302795
Hospital Revenue Code	270
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$38.17
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.54
Rate for Payer: Oxford Commercial	$63.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$63.62

IMMOBILIZER KNEE SM

Facility

$127.25

Hospital Charge Code	270302795
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE XLG

Facility

$127.25

Hospital Charge Code	270302825
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE XLG

Facility

$127.25

Hospital Charge Code	270302825
Hospital Revenue Code	270
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$38.17
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.54
Rate for Payer: Oxford Commercial	$63.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$63.62

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$76.28
Rate for Payer: Aetna Commercial	$45.77
Rate for Payer: Aetna Medicare Advantage	$45.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.90
Rate for Payer: Cigna Commercial	$76.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.83
Rate for Payer: Oxford Commercial	$76.28
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$76.28

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$74.53
Rate for Payer: Aetna Commercial	$44.72
Rate for Payer: Aetna Medicare Advantage	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.01
Rate for Payer: Cigna Commercial	$74.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.38
Rate for Payer: Oxford Commercial	$74.53
Rate for Payer: Qualcare PPO/HMO/WC	$22.36
Rate for Payer: UnitedHealthcare Commercial	$74.53

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$22.36
Rate for Payer: Qualcare PPO/HMO/WC	$22.36

IMMOBILIZER KNEE XXL

Facility

$124.85

Hospital Charge Code	270302800
Hospital Revenue Code	270
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.23
Rate for Payer: Oxford Commercial	$62.42
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$62.42

IMMOBILIZER KNEE XXL

Facility

$124.85

Hospital Charge Code	270302800
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

IMMOBILIZER SHOULDER

Facility

$39.75

Hospital Charge Code	270665592
Hospital Revenue Code	270
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$19.88
Rate for Payer: Aetna Commercial	$11.93
Rate for Payer: Aetna Medicare Advantage	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.14
Rate for Payer: Cigna Commercial	$19.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.96
Rate for Payer: UnitedHealthcare Commercial	$19.88

IMMOBILIZER SHOULDER

Facility

$39.75

Hospital Charge Code	270665592
Hospital Revenue Code	270
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.96

IMMOBILIZER SHOULDER ******

Facility

$49.00

Hospital Charge Code	8002065
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

IMMOBILIZER SHOULDER ******

Facility

$49.00

Hospital Charge Code	8002065
Hospital Revenue Code	279
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

IMMOBILIZER SHOULDER LG

Facility

$30.00

Hospital Charge Code	270677150
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER LG

Facility

$30.00

Hospital Charge Code	270677150
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

IMMOBILIZER SHOULDER MED

Facility

$30.00

Hospital Charge Code	270677149
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER MED

Facility

$30.00

Hospital Charge Code	270677149
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

IMMOBILIZER SHOULDER ONE SZ

Facility

$42.65

Service Code	HCPCS L3650
Hospital Charge Code	270302813
Hospital Revenue Code	274
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

IMMOBILIZER SHOULDER ONE SZ

Facility

$42.65

Service Code	HCPCS L3650
Hospital Charge Code	270302813
Hospital Revenue Code	274
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$76.59
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.88
Rate for Payer: Cigna Commercial	$76.59
Rate for Payer: Cigna Medicare Advantage	$45.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

IMMOBILIZER SHOULDER SML

Facility

$30.00

Hospital Charge Code	270677148
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER SML

Facility

$30.00

Hospital Charge Code	270677148
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

IMMOBILIZER SHOULDER XL

Facility

$30.00

Hospital Charge Code	270677151
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

IMMOBILIZER SHOULDER XL

Facility

$30.00

Hospital Charge Code	270677151
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

Know your out-of-pocket cost for care.

All Charges