Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT HEMOVAC 400CC 1/8 2500-000

Facility

$108.00

Hospital Charge Code	270607623
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

KIT HEMOVAC 400CC 5390-040

Facility

$246.45

Hospital Charge Code	270600375
Hospital Revenue Code	272
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$123.22
Rate for Payer: Aetna Commercial	$73.94
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.04
Rate for Payer: Oxford Commercial	$123.22
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$123.22

KIT HEMOVAC 400CC 5390-040

Facility

$246.45

Hospital Charge Code	270600375
Hospital Revenue Code	272
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

KIT HIP ARTHO W/ BANANA BLADE

Facility

$1,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270681364
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

KIT HIP ARTHO W/ BANANA BLADE

Facility

$1,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270681364
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

KIT HIP ARTHROSCOPY MSTR W/BLD

Facility

$2,250.00

Hospital Charge Code	270675642
Hospital Revenue Code	272
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$1,125.00

KIT HIP ARTHROSCOPY MSTR W/BLD

Facility

$2,250.00

Hospital Charge Code	270675642
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT HVAC 400 EVACTOR 254000010

Facility

$82.75

Hospital Charge Code	270632891
Hospital Revenue Code	272
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$12.41
Rate for Payer: Qualcare PPO/HMO/WC	$12.41

KIT HVAC 400 EVACTOR 254000010

Facility

$82.75

Hospital Charge Code	270632891
Hospital Revenue Code	272
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$41.38
Rate for Payer: Aetna Commercial	$24.82
Rate for Payer: Aetna Medicare Advantage	$24.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.10
Rate for Payer: Cigna Commercial	$41.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.76
Rate for Payer: Oxford Commercial	$41.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.41
Rate for Payer: UnitedHealthcare Commercial	$41.38

KIT ICP COMPL ADULT 80-1190

Facility

$2,096.85

Hospital Charge Code	270600325
Hospital Revenue Code	272
Min. Negotiated Rate	$314.53
Max. Negotiated Rate	$314.53
Rate for Payer: Qualcare PPO/HMO/WC	$314.53

KIT ICP COMPL ADULT 80-1190

Facility

$2,096.85

Hospital Charge Code	270600325
Hospital Revenue Code	272
Min. Negotiated Rate	$272.59
Max. Negotiated Rate	$1,048.42
Rate for Payer: Aetna Commercial	$629.05
Rate for Payer: Aetna Medicare Advantage	$629.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.70
Rate for Payer: Cigna Commercial	$1,048.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.59
Rate for Payer: Oxford Commercial	$1,048.42
Rate for Payer: Qualcare PPO/HMO/WC	$314.53
Rate for Payer: UnitedHealthcare Commercial	$1,048.42

KIT IMPI DRILL W/DT320 DDK320

Facility

$323.25

Hospital Charge Code	270620305
Hospital Revenue Code	272
Min. Negotiated Rate	$42.02
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$96.97
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.02
Rate for Payer: Oxford Commercial	$161.62
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Commercial	$161.62

KIT IMPI DRILL W/DT320 DDK320

Facility

$323.25

Hospital Charge Code	270620305
Hospital Revenue Code	272
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$48.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

KIT IMPLANT ANKLE SYNDESMOSIS

Facility

$425.00

Hospital Charge Code	270655838
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

KIT IMPLANT ANKLE SYNDESMOSIS

Facility

$425.00

Hospital Charge Code	270655838
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

KIT IMPLANT BRCE SYST AR1638CP

Facility

$8,099.00

Service Code	HCPCS C1713
Hospital Charge Code	270698671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,214.85
Max. Negotiated Rate	$1,959.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,619.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,959.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,214.85

KIT IMPLANT BRCE SYST AR1638CP

Facility

$8,099.00

Service Code	HCPCS C1713
Hospital Charge Code	270698671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,214.85
Max. Negotiated Rate	$4,049.50
Rate for Payer: Aetna Commercial	$2,429.70
Rate for Payer: Aetna Medicare Advantage	$2,429.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,065.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,065.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,619.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,065.24
Rate for Payer: Cigna Commercial	$4,049.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,959.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,214.85

KIT IMPLANT TOE SGARLATO B

Facility

$3,218.45

Hospital Charge Code	270608799
Hospital Revenue Code	278
Min. Negotiated Rate	$482.77
Max. Negotiated Rate	$778.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.86
Rate for Payer: Qualcare PPO/HMO/WC	$482.77

KIT IMPLANT TOE SGARLATO B

Facility

$3,218.45

Hospital Charge Code	270608799
Hospital Revenue Code	278
Min. Negotiated Rate	$482.77
Max. Negotiated Rate	$1,609.22
Rate for Payer: Qualcare PPO/HMO/WC	$482.77
Rate for Payer: Aetna Commercial	$965.53
Rate for Payer: Aetna Medicare Advantage	$965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$820.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$820.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$820.70
Rate for Payer: Cigna Commercial	$1,609.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.86

KIT INFLATION SYRINGE 3-WAY

Facility

$225.00

Hospital Charge Code	270658333
Hospital Revenue Code	271
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

KIT INFLATION SYRINGE 3-WAY

Facility

$225.00

Hospital Charge Code	270658333
Hospital Revenue Code	271
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$112.50

KIT INFUSAID REFILL ******

Facility

$78.00

Hospital Charge Code	7000870
Hospital Revenue Code	272
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$39.00

KIT INFUSAID REFILL ******

Facility

$78.00

Hospital Charge Code	7000870
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

KIT INFUSAID REFILL 40820

Facility

$37.65

Hospital Charge Code	270600825
Hospital Revenue Code	272
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$11.29
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.89
Rate for Payer: Oxford Commercial	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$18.82

KIT INFUSAID REFILL 40820

Facility

$37.65

Hospital Charge Code	270600825
Hospital Revenue Code	272
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

Know your out-of-pocket cost for care.

All Charges