Heights University Hospital

All Charges

Charge

Type

Setting

Price

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$28.47
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$65.70
Rate for Payer: Aetna Medicare Advantage	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.84
Rate for Payer: Cigna Commercial	$109.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.47
Rate for Payer: Oxford Commercial	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.85
Rate for Payer: UnitedHealthcare Commercial	$109.50

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$32.85
Rate for Payer: Qualcare PPO/HMO/WC	$32.85

ORTHOSIS MOLD ANKLE CUSTOM

Facility

$3,157.65

Hospital Charge Code	270613508
Hospital Revenue Code	274
Min. Negotiated Rate	$473.65
Max. Negotiated Rate	$764.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.15
Rate for Payer: Qualcare PPO/HMO/WC	$473.65

ORTHOSIS MOLD ANKLE CUSTOM

Facility

$3,157.65

Hospital Charge Code	270613508
Hospital Revenue Code	274
Min. Negotiated Rate	$473.65
Max. Negotiated Rate	$1,578.83
Rate for Payer: Aetna Commercial	$947.29
Rate for Payer: Aetna Medicare Advantage	$947.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$805.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$805.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$805.20
Rate for Payer: Cigna Commercial	$1,578.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.15
Rate for Payer: Qualcare PPO/HMO/WC	$473.65

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$765.00
Rate for Payer: Aetna Medicare Advantage	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.25
Rate for Payer: Cigna Commercial	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$330.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$682.50
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Aetna Medicare Advantage	$409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.07
Rate for Payer: Cigna Commercial	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$8.07
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.12
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$8.07

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$89.70
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.87
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$686.00

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$686.00
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) NJ Health	$90.00
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	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$686.00

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$41.10
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$51.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.81
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$686.00

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$41.10
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.81
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$686.00

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$686.00

OR TRIAL PRODUCT - PORT C1788

Facility

$0.01

Service Code	HCPCS C1788
Hospital Charge Code	1699999
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OR TRIAL PRODUCT - PORT C1788

Facility

$0.01

Service Code	HCPCS C1788
Hospital Charge Code	1699999
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ORUDIS/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ORUDIS/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633589
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

ORUDIS/75MG/CAP

Facility

$3.00

Hospital Charge Code	60633590
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

Know your out-of-pocket cost for care.

All Charges