Heights University Hospital

All Charges

Charge

Type

Setting

Price

SET SCREW PEDICLE 4.15X9MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693617
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

SET SCREW PEDICLE 4.15X9MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693617
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

SET SCREWS

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703859
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SET SCREWS

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703859
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SET SCREWS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705515
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

SET SCREWS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705515
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

SET SMN SCREW IM HIP HN1202

Facility

$668.85

Hospital Charge Code	270621506
Hospital Revenue Code	278
Min. Negotiated Rate	$100.33
Max. Negotiated Rate	$334.43
Rate for Payer: Aetna Commercial	$200.66
Rate for Payer: Aetna Medicare Advantage	$200.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.56
Rate for Payer: Cigna Commercial	$334.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.86
Rate for Payer: Qualcare PPO/HMO/WC	$100.33

SET SMN SCREW IM HIP HN1202

Facility

$668.85

Hospital Charge Code	270621506
Hospital Revenue Code	278
Min. Negotiated Rate	$100.33
Max. Negotiated Rate	$161.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.86
Rate for Payer: Qualcare PPO/HMO/WC	$100.33

SET SPRAY FOR TISSO DEV 921031

Facility

$198.45

Hospital Charge Code	270635063
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

SET SPRAY FOR TISSO DEV 921031

Facility

$198.45

Hospital Charge Code	270635063
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$59.53
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$99.22
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$99.22

SET STRY ARTHRSC PUMP 0350202

Facility

$248.00

Hospital Charge Code	270620476
Hospital Revenue Code	272
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.40
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.24
Rate for Payer: Oxford Commercial	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$124.00

SET STRY ARTHRSC PUMP 0350202

Facility

$248.00

Hospital Charge Code	270620476
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

SET SUTURE DISP

Facility

$28.17

Hospital Charge Code	270600744
Hospital Revenue Code	272
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

SET SUTURE DISP

Facility

$28.17

Hospital Charge Code	270600744
Hospital Revenue Code	272
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$14.09
Rate for Payer: Aetna Commercial	$8.45
Rate for Payer: Aetna Medicare Advantage	$8.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$14.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$14.09

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$2.64
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$2.64

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266
Hospital Revenue Code	272
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$2.64
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$2.64

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET THORACIC DUAL DRAIN 571505

Facility

$116.85

Hospital Charge Code	270606360
Hospital Revenue Code	270
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$35.05
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$58.42
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$58.42

SET THORACIC DUAL DRAIN 571505

Facility

$116.85

Hospital Charge Code	270606360
Hospital Revenue Code	270
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

SET THROMBECTOMY DVX ULTRA

Facility

$9,025.00

Hospital Charge Code	270645567C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

SET THROMBECTOMY DVX ULTRA

Facility

$9,025.00

Hospital Charge Code	270645567C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$4,512.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$4,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

SET THROMBECTOMY XPEEDIOR

Facility

$7,975.00

Hospital Charge Code	270645566C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

SET THROMBECTOMY XPEEDIOR

Facility

$7,975.00

Hospital Charge Code	270645566C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$2,392.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,067.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

Know your out-of-pocket cost for care.

All Charges