Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT SCP FOOT AND ANKLE

Facility

$15,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270688551
Hospital Revenue Code	278
Min. Negotiated Rate	$2,385.00
Max. Negotiated Rate	$7,950.00
Rate for Payer: Aetna Commercial	$4,770.00
Rate for Payer: Aetna Medicare Advantage	$4,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,054.50
Rate for Payer: Cigna Commercial	$7,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,847.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,385.00

KIT SCP FOOT AND ANKLE

Facility

$15,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270688551
Hospital Revenue Code	278
Min. Negotiated Rate	$2,385.00
Max. Negotiated Rate	$3,847.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,847.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,385.00

KIT SCP FOOT & ANKLE

Facility

$10,000.00

Hospital Charge Code	270677705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,000.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

KIT SCP FOOT & ANKLE

Facility

$10,000.00

Hospital Charge Code	270677705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

KIT SCP KNEE

Facility

$20,375.00

Hospital Charge Code	270678971
Hospital Revenue Code	272
Min. Negotiated Rate	$2,648.75
Max. Negotiated Rate	$10,187.50
Rate for Payer: Aetna Commercial	$6,112.50
Rate for Payer: Aetna Medicare Advantage	$6,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,195.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,195.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,195.62
Rate for Payer: Cigna Commercial	$10,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,648.75
Rate for Payer: Oxford Commercial	$10,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.25
Rate for Payer: UnitedHealthcare Commercial	$10,187.50

KIT SCP KNEE

Facility

$20,375.00

Hospital Charge Code	270678971
Hospital Revenue Code	272
Min. Negotiated Rate	$3,056.25
Max. Negotiated Rate	$3,056.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.25

KIT SCREW LOCKING CAP 4.5X22MM

Facility

$601.60

Service Code	HCPCS C1713
Hospital Charge Code	270668812
Hospital Revenue Code	278
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$145.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.24

KIT SCREW LOCKING CAP 4.5X22MM

Facility

$601.60

Service Code	HCPCS C1713
Hospital Charge Code	270668812
Hospital Revenue Code	278
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$300.80
Rate for Payer: Aetna Commercial	$180.48
Rate for Payer: Aetna Medicare Advantage	$180.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.41
Rate for Payer: Cigna Commercial	$300.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.24

KIT SDK BONE GRAFT 7510200

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270629242
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$5,250.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

KIT SDK BONE GRAFT 7510200

Facility

$17,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270629242
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

KIT SEPARATION PLATE 8001001A

Facility

$2,505.00

Hospital Charge Code	270633430
Hospital Revenue Code	272
Min. Negotiated Rate	$375.75
Max. Negotiated Rate	$375.75
Rate for Payer: Qualcare PPO/HMO/WC	$375.75

KIT SEPARATION PLATE 8001001A

Facility

$2,505.00

Hospital Charge Code	270633430
Hospital Revenue Code	272
Min. Negotiated Rate	$325.65
Max. Negotiated Rate	$1,252.50
Rate for Payer: Aetna Commercial	$751.50
Rate for Payer: Aetna Medicare Advantage	$751.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$638.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$638.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$638.77
Rate for Payer: Cigna Commercial	$1,252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.65
Rate for Payer: Oxford Commercial	$1,252.50
Rate for Payer: Qualcare PPO/HMO/WC	$375.75
Rate for Payer: UnitedHealthcare Commercial	$1,252.50

KIT SEPS W/5MM TROCAR SPSKT-01

Facility

$2,559.25

Hospital Charge Code	270614817
Hospital Revenue Code	272
Min. Negotiated Rate	$383.89
Max. Negotiated Rate	$383.89
Rate for Payer: Qualcare PPO/HMO/WC	$383.89

KIT SEPS W/5MM TROCAR SPSKT-01

Facility

$2,559.25

Hospital Charge Code	270614817
Hospital Revenue Code	272
Min. Negotiated Rate	$332.70
Max. Negotiated Rate	$1,279.62
Rate for Payer: Aetna Commercial	$767.77
Rate for Payer: Aetna Medicare Advantage	$767.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$652.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$652.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$652.61
Rate for Payer: Cigna Commercial	$1,279.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.70
Rate for Payer: Oxford Commercial	$1,279.62
Rate for Payer: Qualcare PPO/HMO/WC	$383.89
Rate for Payer: UnitedHealthcare Commercial	$1,279.62

KIT SERVICE PACEMAKER 5873C

Facility

$346.45

Hospital Charge Code	270608505
Hospital Revenue Code	270
Min. Negotiated Rate	$45.04
Max. Negotiated Rate	$173.22
Rate for Payer: Aetna Commercial	$103.94
Rate for Payer: Aetna Medicare Advantage	$103.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$173.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.04
Rate for Payer: Oxford Commercial	$173.22
Rate for Payer: Qualcare PPO/HMO/WC	$51.97
Rate for Payer: UnitedHealthcare Commercial	$173.22

KIT SERVICE PACEMAKER 5873C

Facility

$346.45

Hospital Charge Code	270608505
Hospital Revenue Code	270
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$51.97
Rate for Payer: Qualcare PPO/HMO/WC	$51.97

KIT SGL TOE IMPLANT 70 B

Facility

$2,681.65

Hospital Charge Code	270611426
Hospital Revenue Code	278
Min. Negotiated Rate	$402.25
Max. Negotiated Rate	$648.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.96
Rate for Payer: Qualcare PPO/HMO/WC	$402.25

KIT SGL TOE IMPLANT 70 B

Facility

$2,681.65

Hospital Charge Code	270611426
Hospital Revenue Code	278
Min. Negotiated Rate	$402.25
Max. Negotiated Rate	$1,340.83
Rate for Payer: Aetna Commercial	$804.50
Rate for Payer: Aetna Medicare Advantage	$804.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.82
Rate for Payer: Cigna Commercial	$1,340.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.96
Rate for Payer: Qualcare PPO/HMO/WC	$402.25

KIT SHOULDER STABILIZATION

Facility

$333.38

Hospital Charge Code	270652581
Hospital Revenue Code	270
Min. Negotiated Rate	$50.01
Max. Negotiated Rate	$50.01
Rate for Payer: Qualcare PPO/HMO/WC	$50.01

KIT SHOULDER STABILIZATION

Facility

$333.38

Hospital Charge Code	270652581
Hospital Revenue Code	270
Min. Negotiated Rate	$43.34
Max. Negotiated Rate	$166.69
Rate for Payer: Aetna Commercial	$100.01
Rate for Payer: Aetna Medicare Advantage	$100.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.01
Rate for Payer: Cigna Commercial	$166.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.34
Rate for Payer: Oxford Commercial	$166.69
Rate for Payer: Qualcare PPO/HMO/WC	$50.01
Rate for Payer: UnitedHealthcare Commercial	$166.69

KIT SHOULDER SUSPENSION ******

Facility

$135.00

Hospital Charge Code	1606623
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

KIT SHOULDER SUSPENSION ******

Facility

$135.00

Hospital Charge Code	1606623
Hospital Revenue Code	272
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$67.50

KIT SHOULDER SUSPENSION 3583

Facility

$415.63

Hospital Charge Code	270605461
Hospital Revenue Code	272
Min. Negotiated Rate	$54.03
Max. Negotiated Rate	$207.81
Rate for Payer: Aetna Commercial	$124.69
Rate for Payer: Aetna Medicare Advantage	$124.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.99
Rate for Payer: Cigna Commercial	$207.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.03
Rate for Payer: Oxford Commercial	$207.81
Rate for Payer: Qualcare PPO/HMO/WC	$62.34
Rate for Payer: UnitedHealthcare Commercial	$207.81

KIT SHOULDER SUSPENSION 3583

Facility

$415.63

Hospital Charge Code	270605461
Hospital Revenue Code	272
Min. Negotiated Rate	$62.34
Max. Negotiated Rate	$62.34
Rate for Payer: Qualcare PPO/HMO/WC	$62.34

KIT SKINTE REGENERATE HARVEST

Facility

$300.00

Service Code	HCPCS Q4200
Hospital Charge Code	270685478
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$296.35
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

Know your out-of-pocket cost for care.

All Charges