Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT ORTHOSORB PIN *******

Facility

$473.00

Hospital Charge Code	1604735
Hospital Revenue Code	274
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$114.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.47
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

KIT ORTHOSORB PIN *******

Facility

$473.00

Hospital Charge Code	1604735
Hospital Revenue Code	274
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$236.50
Rate for Payer: Aetna Commercial	$141.90
Rate for Payer: Aetna Medicare Advantage	$141.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.61
Rate for Payer: Cigna Commercial	$236.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.47
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

KIT ORTHOSORB PIN 84-1070

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270601198
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$340.50
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

KIT ORTHOSORB PIN 84-1070

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270601198
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

KIT ORTHOSORB PIN 84-2052

Facility

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270601204
Hospital Revenue Code	278
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$335.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

KIT ORTHOSORB PIN 84-2052

Facility

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270601204
Hospital Revenue Code	278
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$692.50
Rate for Payer: Aetna Commercial	$415.50
Rate for Payer: Aetna Medicare Advantage	$415.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.18
Rate for Payer: Cigna Commercial	$692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

KIT OS WILSON FRAME 5322

Facility

$958.45

Hospital Charge Code	270627625
Hospital Revenue Code	270
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$479.23
Rate for Payer: Aetna Commercial	$287.54
Rate for Payer: Aetna Medicare Advantage	$287.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.40
Rate for Payer: Cigna Commercial	$479.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.60
Rate for Payer: Oxford Commercial	$479.23
Rate for Payer: Qualcare PPO/HMO/WC	$143.77
Rate for Payer: UnitedHealthcare Commercial	$479.23

KIT OS WILSON FRAME 5322

Facility

$958.45

Hospital Charge Code	270627625
Hospital Revenue Code	270
Min. Negotiated Rate	$143.77
Max. Negotiated Rate	$143.77
Rate for Payer: Qualcare PPO/HMO/WC	$143.77

KIT PAD POSITIONING

Facility

$265.00

Hospital Charge Code	270677848
Hospital Revenue Code	272
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

KIT PAD POSITIONING

Facility

$265.00

Hospital Charge Code	270677848
Hospital Revenue Code	272
Min. Negotiated Rate	$34.45
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$79.50
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.45
Rate for Payer: Oxford Commercial	$132.50
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$132.50

KIT PAT CARE ANDREW FRAME 946S

Facility

$295.25

Hospital Charge Code	270606434
Hospital Revenue Code	272
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$44.29
Rate for Payer: Qualcare PPO/HMO/WC	$44.29

KIT PAT CARE ANDREW FRAME 946S

Facility

$295.25

Hospital Charge Code	270606434
Hospital Revenue Code	272
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$147.62
Rate for Payer: Aetna Commercial	$88.58
Rate for Payer: Aetna Medicare Advantage	$88.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.29
Rate for Payer: Cigna Commercial	$147.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.38
Rate for Payer: Oxford Commercial	$147.62
Rate for Payer: Qualcare PPO/HMO/WC	$44.29
Rate for Payer: UnitedHealthcare Commercial	$147.62

KIT PATELLA TEMPLATE ANTERIOR

Facility

$965.25

Hospital Charge Code	270694963
Hospital Revenue Code	272
Min. Negotiated Rate	$125.48
Max. Negotiated Rate	$482.62
Rate for Payer: Aetna Commercial	$289.57
Rate for Payer: Aetna Medicare Advantage	$289.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.14
Rate for Payer: Cigna Commercial	$482.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.48
Rate for Payer: Oxford Commercial	$482.62
Rate for Payer: Qualcare PPO/HMO/WC	$144.79
Rate for Payer: UnitedHealthcare Commercial	$482.62

KIT PATELLA TEMPLATE ANTERIOR

Facility

$965.25

Hospital Charge Code	270694963
Hospital Revenue Code	272
Min. Negotiated Rate	$144.79
Max. Negotiated Rate	$144.79
Rate for Payer: Qualcare PPO/HMO/WC	$144.79

KIT PATIENT PROGRAMMER SC55002

Facility

$5,975.00

Hospital Charge Code	270641626
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$1,792.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

KIT PATIENT PROGRAMMER SC55002

Facility

$5,975.00

Hospital Charge Code	270641626
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

KIT PEEK ROOT REPAIR

Facility

$6,975.00

Hospital Charge Code	270688311
Hospital Revenue Code	272
Min. Negotiated Rate	$906.75
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,092.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.75
Rate for Payer: Oxford Commercial	$3,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$3,487.50

KIT PEEK ROOT REPAIR

Facility

$6,975.00

Hospital Charge Code	270688311
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

KIT PEG 24FR SAFETY PUSH

Facility

$442.18

Hospital Charge Code	270676987
Hospital Revenue Code	278
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$107.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.01
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

KIT PEG 24FR SAFETY PUSH

Facility

$442.18

Hospital Charge Code	270676987
Hospital Revenue Code	278
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$221.09
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare Advantage	$132.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.01
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

KIT PEG SAFETY 20FR PULL

Facility

$442.18

Hospital Charge Code	270647892
Hospital Revenue Code	272
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$221.09
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare Advantage	$132.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.48
Rate for Payer: Oxford Commercial	$221.09
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$221.09

KIT PEG SAFETY 20FR PULL

Facility

$442.18

Hospital Charge Code	270647892
Hospital Revenue Code	272
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

KIT PEG SAFETY 20FR PUSH 6647

Facility

$1,125.00

Hospital Charge Code	270647893
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

KIT PEG SAFETY 20FR PUSH 6647

Facility

$1,125.00

Hospital Charge Code	270647893
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.25
Rate for Payer: Oxford Commercial	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$562.50

KIT PEN & LABEL

Facility

$3.10

Hospital Charge Code	270636909C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$1.55
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.79
Rate for Payer: Cigna Commercial	$1.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.40
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$0.47
Rate for Payer: UnitedHealthcare Commercial	$1.55

Know your out-of-pocket cost for care.

All Charges