Heights University Hospital

All Charges

Charge

Type

Setting

Price

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$8,242.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$94.25
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$217.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.25
Rate for Payer: Oxford Commercial	$362.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$362.50

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$5,061.00
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$5,061.00
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$5,436.00
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$5,061.00
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$5,436.00
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$8,242.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SYSTEM 3R SK23

Facility

$37,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270697749
Hospital Revenue Code	278
Min. Negotiated Rate	$5,620.50
Max. Negotiated Rate	$18,735.00
Rate for Payer: Aetna Commercial	$11,241.00
Rate for Payer: Aetna Medicare Advantage	$11,241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,554.85
Rate for Payer: Cigna Commercial	$18,735.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,067.74
Rate for Payer: Qualcare PPO/HMO/WC	$5,620.50

LAPIPLASTY SYSTEM 3R SK23

Facility

$37,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270697749
Hospital Revenue Code	278
Min. Negotiated Rate	$5,620.50
Max. Negotiated Rate	$9,067.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,494.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,067.74
Rate for Payer: Qualcare PPO/HMO/WC	$5,620.50

LAPIPLASTY SYSTEM S4A

Facility

$25,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696718
Hospital Revenue Code	278
Min. Negotiated Rate	$3,896.25
Max. Negotiated Rate	$12,987.50
Rate for Payer: Aetna Commercial	$7,792.50
Rate for Payer: Aetna Medicare Advantage	$7,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,623.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,623.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,623.62
Rate for Payer: Cigna Commercial	$12,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,285.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,896.25

LAPIPLASTY SYSTEM S4A

Facility

$25,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696718
Hospital Revenue Code	278
Min. Negotiated Rate	$3,896.25
Max. Negotiated Rate	$6,285.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,285.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,896.25

LAPI SPEEDPLATE MIC QUAD 14MM

Facility

$19,370.00

Hospital Charge Code	270702793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,905.50
Max. Negotiated Rate	$9,685.00
Rate for Payer: Aetna Commercial	$5,811.00
Rate for Payer: Aetna Medicare Advantage	$5,811.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,939.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,939.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,874.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,939.35
Rate for Payer: Cigna Commercial	$9,685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,687.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,905.50

LAPI SPEEDPLATE MIC QUAD 14MM

Facility

$19,370.00

Hospital Charge Code	270702793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,905.50
Max. Negotiated Rate	$4,687.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,874.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,687.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,905.50

LAPI SPEEDPLATE MIC QUAD 17MM

Facility

$19,370.00

Hospital Charge Code	270703012
Hospital Revenue Code	278
Min. Negotiated Rate	$2,905.50
Max. Negotiated Rate	$9,685.00
Rate for Payer: Aetna Commercial	$5,811.00
Rate for Payer: Aetna Medicare Advantage	$5,811.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,939.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,939.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,874.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,939.35
Rate for Payer: Cigna Commercial	$9,685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,687.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,905.50

Know your out-of-pocket cost for care.

All Charges