Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT SWNSN TITANUM TOE 2483KITA

Facility

$6,919.25

Hospital Charge Code	270611922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,037.89
Max. Negotiated Rate	$3,459.62
Rate for Payer: Aetna Commercial	$2,075.78
Rate for Payer: Aetna Medicare Advantage	$2,075.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,764.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,764.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,383.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,764.41
Rate for Payer: Cigna Commercial	$3,459.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,674.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,037.89

KIT SYNDEX WITH CONSTRICTOR

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270700499
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

KIT SYNDEX WITH CONSTRICTOR

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270700499
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

KIT TESIO REPAIR BLUE MC11V

Facility

$100.85

Hospital Charge Code	270608511
Hospital Revenue Code	272
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11

KIT TESIO REPAIR BLUE MC11V

Facility

$100.85

Hospital Charge Code	270608511
Hospital Revenue Code	272
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

KIT TESIO REPAIR RED MC11A

Facility

$100.85

Hospital Charge Code	270608510
Hospital Revenue Code	272
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

KIT TESIO REPAIR RED MC11A

Facility

$100.85

Hospital Charge Code	270608510
Hospital Revenue Code	272
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$30.25
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.11
Rate for Payer: Oxford Commercial	$50.42
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$50.42

KIT TESSYS ACCESS #2

Facility

$3,360.00

Hospital Charge Code	270647009
Hospital Revenue Code	272
Min. Negotiated Rate	$436.80
Max. Negotiated Rate	$1,680.00
Rate for Payer: Aetna Commercial	$1,008.00
Rate for Payer: Aetna Medicare Advantage	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.80
Rate for Payer: Cigna Commercial	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.80
Rate for Payer: Oxford Commercial	$1,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$504.00
Rate for Payer: UnitedHealthcare Commercial	$1,680.00

KIT TESSYS ACCESS #2

Facility

$3,360.00

Hospital Charge Code	270647009
Hospital Revenue Code	272
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$504.00
Rate for Payer: Qualcare PPO/HMO/WC	$504.00

KIT THERAPEUT PHERESIS 11010**

Facility

$1,164.00

Hospital Charge Code	270600822
Hospital Revenue Code	270
Min. Negotiated Rate	$174.60
Max. Negotiated Rate	$174.60
Rate for Payer: Qualcare PPO/HMO/WC	$174.60

KIT THERAPEUT PHERESIS 11010**

Facility

$1,164.00

Hospital Charge Code	270600822
Hospital Revenue Code	270
Min. Negotiated Rate	$151.32
Max. Negotiated Rate	$582.00
Rate for Payer: Aetna Commercial	$349.20
Rate for Payer: Aetna Medicare Advantage	$349.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.82
Rate for Payer: Cigna Commercial	$582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.32
Rate for Payer: Oxford Commercial	$582.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.60
Rate for Payer: UnitedHealthcare Commercial	$582.00

KIT THERAPEUT PHERESIS 9164***

Facility

$805.00

Hospital Charge Code	270600823
Hospital Revenue Code	270
Min. Negotiated Rate	$104.65
Max. Negotiated Rate	$402.50
Rate for Payer: Aetna Commercial	$241.50
Rate for Payer: Aetna Medicare Advantage	$241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.28
Rate for Payer: Cigna Commercial	$402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.65
Rate for Payer: Oxford Commercial	$402.50
Rate for Payer: Qualcare PPO/HMO/WC	$120.75
Rate for Payer: UnitedHealthcare Commercial	$402.50

KIT THERAPEUT PHERESIS 9164***

Facility

$805.00

Hospital Charge Code	270600823
Hospital Revenue Code	270
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$120.75
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

KIT TIBIA CR SZ 2

Facility

$1,750.00

Hospital Charge Code	270700540
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

KIT TIBIA CR SZ 2

Facility

$1,750.00

Hospital Charge Code	270700540
Hospital Revenue Code	272
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$875.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$875.00

KIT TIGHTROPE 8.5 MM FLIPCUT I

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270682535
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

KIT TIGHTROPE 8.5 MM FLIPCUT I

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270682535
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,042.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

KIT TIGHTROPE DUAL

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683592
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$3,525.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

KIT TIGHTROPE DUAL

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683592
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

KIT TITAN ASSEMBLY 91-9480SC

Facility

$2,250.00

Hospital Charge Code	270640425
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 TITAN ASSEMBLY 91-9480SC

Facility

$2,250.00

Hospital Charge Code	270640425
Hospital Revenue Code	272
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

KIT TOGGLELOC 909846

Facility

$3,825.00

Hospital Charge Code	270647899
Hospital Revenue Code	272
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$573.75
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

KIT TOGGLELOC 909846

Facility

$3,825.00

Hospital Charge Code	270647899
Hospital Revenue Code	272
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,147.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.25
Rate for Payer: Oxford Commercial	$1,912.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Commercial	$1,912.50

KIT TOOTHETTE PLUS W/PEROXIDE

Facility

$409.00

Hospital Charge Code	270649848
Hospital Revenue Code	270
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

KIT TOOTHETTE PLUS W/PEROXIDE

Facility

$409.00

Hospital Charge Code	270649848
Hospital Revenue Code	270
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$122.70
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Oxford Commercial	$204.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$204.50

Know your out-of-pocket cost for care.

All Charges