Heights University Hospital

All Charges

Charge

Type

Setting

Price

L-PLATE LCP LF 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667167
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$486.00
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE LCP LF 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667167
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE LCP RT 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667166
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$486.00
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE LCP RT 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667166
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE OBLIQUE LF 2H 2x20MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604340
Hospital Revenue Code	278
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$117.42
Rate for Payer: Aetna Commercial	$70.45
Rate for Payer: Aetna Medicare Advantage	$70.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.89
Rate for Payer: Cigna Commercial	$117.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$35.23

L-PLATE OBLIQUE LF 2H 2x20MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604340
Hospital Revenue Code	278
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$56.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$35.23

L-PLATE OBLIQUE LF 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604325
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$129.78
Rate for Payer: Aetna Commercial	$77.86
Rate for Payer: Aetna Medicare Advantage	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.19
Rate for Payer: Cigna Commercial	$129.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBLIQUE LF 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604325
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$62.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBLIQUE RT 2H 2x20MM

Facility

$228.00

Hospital Charge Code	270665619
Hospital Revenue Code	278
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$34.20

L-PLATE OBLIQUE RT 2H 2x20MM

Facility

$228.00

Hospital Charge Code	270665619
Hospital Revenue Code	278
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$68.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.14
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$34.20

L-PLATE OBLIQUE RT 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604326
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$62.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBLIQUE RT 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604326
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$129.78
Rate for Payer: Aetna Commercial	$77.86
Rate for Payer: Aetna Medicare Advantage	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.19
Rate for Payer: Cigna Commercial	$129.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBL RT 2HD 3H 2.7x35MM

Facility

$1,620.00

Hospital Charge Code	270667165
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$486.00
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE OBL RT 2HD 3H 2.7x35MM

Facility

$1,620.00

Hospital Charge Code	270667165
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L.PNEUMOPHILA AB(IGM) I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

L.PNEUMOPHILA AB(IGM) I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

L. PNEUMOPHILA AB(IGM)IFA

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3035106
Hospital Revenue Code	302
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

L. PNEUMOPHILA AB(IGM)IFA

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3035106
Hospital Revenue Code	302
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.06
Rate for Payer: Cigna Commercial	$15.30
Rate for Payer: Cigna Medicare Advantage	$7.65
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16.22
Rate for Payer: Wellcare Medicare Advantage	$15.30

L.PNEUMOPHILA AB(IGM) II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

L.PNEUMOPHILA AB(IGM) II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102B
Hospital Revenue Code	302
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$178.50
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 13MM

Facility

$650.00

Hospital Charge Code	270663854
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

LP NON-LOCK 2.7MM X 13MM

Facility

$650.00

Hospital Charge Code	270663854
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$178.50
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

Know your out-of-pocket cost for care.

All Charges