Heights University Hospital

All Charges

Charge

Type

Setting

Price

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1762
Hospital Charge Code	270674250
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$495.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

OPTEFORM DISC 45MM

Facility

$8,437.50

Hospital Charge Code	270674125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.62
Max. Negotiated Rate	$4,218.75
Rate for Payer: Aetna Commercial	$2,531.25
Rate for Payer: Aetna Medicare Advantage	$2,531.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,151.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,151.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,151.56
Rate for Payer: Cigna Commercial	$4,218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.62

OPTEFORM DISC 45MM

Facility

$8,437.50

Hospital Charge Code	270674125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.62
Max. Negotiated Rate	$2,041.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.62

OPTEMP CAUTERY

Facility

$255.00

Hospital Charge Code	270332557
Hospital Revenue Code	272
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

OPTEMP CAUTERY

Facility

$255.00

Hospital Charge Code	270332557
Hospital Revenue Code	272
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Oxford Commercial	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Commercial	$127.50

OPTICHAMBER

Facility

$45.22

Hospital Charge Code	270651553
Hospital Revenue Code	270
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna Commercial	$13.57
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.53
Rate for Payer: Cigna Commercial	$22.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.88
Rate for Payer: Oxford Commercial	$22.61
Rate for Payer: Qualcare PPO/HMO/WC	$6.78
Rate for Payer: UnitedHealthcare Commercial	$22.61

OPTICHAMBER

Facility

$45.22

Hospital Charge Code	270651553
Hospital Revenue Code	270
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$6.78

OPTICHAMBER HS80010

Facility

$26.35

Hospital Charge Code	270635276
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$13.18
Rate for Payer: Aetna Commercial	$7.91
Rate for Payer: Aetna Medicare Advantage	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.72
Rate for Payer: Cigna Commercial	$13.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.43
Rate for Payer: Oxford Commercial	$13.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.95
Rate for Payer: UnitedHealthcare Commercial	$13.18

OPTICHAMBER HS80010

Facility

$26.35

Hospital Charge Code	270635276
Hospital Revenue Code	272
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.95

OPTICROSS HD 5FR

Facility

$5,625.00

Hospital Charge Code	270703405
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

OPTICROSS HD 5FR

Facility

$5,625.00

Hospital Charge Code	270703405
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

OPTICROSS HD 6 FR

Facility

$5,625.00

Hospital Charge Code	270703406
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

OPTICROSS HD 6 FR

Facility

$5,625.00

Hospital Charge Code	270703406
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$1,687.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

OPTIFIX

Facility

$3,400.00

Hospital Charge Code	270685689
Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

OPTIFIX

Facility

$3,400.00

Hospital Charge Code	270685689
Hospital Revenue Code	272
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,020.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00

OPTILETS-500/TAB

Facility

$3.00

Hospital Charge Code	60633579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OPTILETS-500/TAB

Facility

$3.00

Hospital Charge Code	60633579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

OPTIMUS X FIBER PLUS

Facility

$6,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270703776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

OPTIMUS X FIBER PLUS

Facility

$6,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270703776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,025.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

OPTIMUS X FIBER PLUS 10CC

Facility

$11,625.00

Hospital Charge Code	270703477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

OPTIMUS X FIBER PLUS 10CC

Facility

$11,625.00

Hospital Charge Code	270703477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$3,487.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

OPTIMUS X FIBER PLUS 2.5CC

Facility

$3,625.00

Service Code	HCPCS C1765
Hospital Charge Code	270706190
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

OPTIMUS X FIBER PLUS 2.5CC

Facility

$3,625.00

Service Code	HCPCS C1765
Hospital Charge Code	270706190
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,087.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

OPTIRAY 320

Facility

$249.60

Hospital Charge Code	60635840
Hospital Revenue Code	255
Min. Negotiated Rate	$32.45
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna Commercial	$74.88
Rate for Payer: Aetna Medicare Advantage	$74.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.65
Rate for Payer: Cigna Commercial	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.45
Rate for Payer: Oxford Commercial	$124.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.44
Rate for Payer: UnitedHealthcare Commercial	$124.80

OPTIRAY 320

Facility

$249.60

Hospital Charge Code	60635840
Hospital Revenue Code	255
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$37.44

Know your out-of-pocket cost for care.

All Charges