Heights University Hospital

All Charges

Charge

Type

Setting

Price

PROTECTOR AXOGUARD 2X2MM

Facility

$9,950.00

Service Code	HCPCS C1763
Hospital Charge Code	270696878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$4,975.00
Rate for Payer: Aetna Commercial	$2,985.00
Rate for Payer: Aetna Medicare Advantage	$2,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,537.25
Rate for Payer: Cigna Commercial	$4,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

PROTECTOR AXOGUARD 2X2MM

Facility

$9,950.00

Service Code	HCPCS C1763
Hospital Charge Code	270696878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,407.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

PROTECTOR AXOGUARD 5x40MM

Facility

$9,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270667301
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,274.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PROTECTOR AXOGUARD 5x40MM

Facility

$9,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270667301
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$2,820.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PROTECTOR EYE OPTI-GARD

Facility

$33.00

Hospital Charge Code	270655049
Hospital Revenue Code	270
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

PROTECTOR EYE OPTI-GARD

Facility

$33.00

Hospital Charge Code	270655049
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

PROTECTOR EYE POSEY BILI

Facility

$7.72

Hospital Charge Code	270622843
Hospital Revenue Code	270
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

PROTECTOR EYE POSEY BILI

Facility

$13.65

Hospital Charge Code	270130175
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

PROTECTOR EYE POSEY BILI

Facility

$13.65

Hospital Charge Code	270130175
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

PROTECTOR EYE POSEY BILI

Facility

$7.72

Hospital Charge Code	270622843
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.86
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare Advantage	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.86

PROTECTOR FINGER COT 3

Facility

$6.07

Hospital Charge Code	270649487
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$1.82
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$3.04

PROTECTOR FINGER COT 3

Facility

$6.07

Hospital Charge Code	270649487
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

PROTECTOR GUIDEWIRE***

Facility

$345.00

Hospital Charge Code	2300770
Hospital Revenue Code	279
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$103.50
Rate for Payer: Aetna Medicare Advantage	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.85
Rate for Payer: Oxford Commercial	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$172.50

PROTECTOR GUIDEWIRE***

Facility

$345.00

Hospital Charge Code	2300770
Hospital Revenue Code	279
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

PROTECTOR GUIDEWIRE PLUS-480

Facility

$924.00

Hospital Charge Code	270601182
Hospital Revenue Code	272
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$462.00
Rate for Payer: Aetna Commercial	$277.20
Rate for Payer: Aetna Medicare Advantage	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.62
Rate for Payer: Cigna Commercial	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.12
Rate for Payer: Oxford Commercial	$462.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.60
Rate for Payer: UnitedHealthcare Commercial	$462.00

PROTECTOR GUIDEWIRE PLUS-480

Facility

$924.00

Hospital Charge Code	270601182
Hospital Revenue Code	272
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$138.60

PROTECTOR HEEL/ELBOW LG

Facility

$20.42

Hospital Charge Code	270302855
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

PROTECTOR HEEL/ELBOW LG

Facility

$20.42

Hospital Charge Code	270302855
Hospital Revenue Code	270
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$10.21
Rate for Payer: Aetna Commercial	$6.13
Rate for Payer: Aetna Medicare Advantage	$6.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.21
Rate for Payer: Cigna Commercial	$10.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$10.21

PROTECTOR HEEL & ELBOW LG PR**

Facility

$27.00

Hospital Charge Code	8004368
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

PROTECTOR HEEL & ELBOW LG PR**

Facility

$27.00

Hospital Charge Code	8004368
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

PROTECTOR HELL/ELBOW UNIV

Facility

$269.03

Hospital Charge Code	270649488
Hospital Revenue Code	272
Min. Negotiated Rate	$40.35
Max. Negotiated Rate	$40.35
Rate for Payer: Qualcare PPO/HMO/WC	$40.35

PROTECTOR HELL/ELBOW UNIV

Facility

$269.03

Hospital Charge Code	270649488
Hospital Revenue Code	272
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$134.51
Rate for Payer: Aetna Commercial	$80.71
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.60
Rate for Payer: Cigna Commercial	$134.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.97
Rate for Payer: Oxford Commercial	$134.51
Rate for Payer: Qualcare PPO/HMO/WC	$40.35
Rate for Payer: UnitedHealthcare Commercial	$134.51

PROTECTOR SAVE-A-TOOTH

Facility

$76.85

Hospital Charge Code	270600767
Hospital Revenue Code	270
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$23.05
Rate for Payer: Aetna Medicare Advantage	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.60
Rate for Payer: Cigna Commercial	$38.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.99
Rate for Payer: Oxford Commercial	$38.42
Rate for Payer: Qualcare PPO/HMO/WC	$11.53
Rate for Payer: UnitedHealthcare Commercial	$38.42

PROTECTOR SAVE-A-TOOTH

Facility

$76.85

Hospital Charge Code	270600767
Hospital Revenue Code	270
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

PROTECTOR TEETH PLASTIC

Facility

$292.85

Hospital Charge Code	270600309
Hospital Revenue Code	272
Min. Negotiated Rate	$43.93
Max. Negotiated Rate	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$43.93

Know your out-of-pocket cost for care.

All Charges