Heights University Hospital

All Charges

Charge

Type

Setting

Price

BASALJEL/400MG/5ML

Facility

$28.00

Hospital Charge Code	60632531
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

BASALJEL/500MG/CAP

Facility

$3.00

Hospital Charge Code	60632532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BASALJEL/500MG/CAP

Facility

$3.00

Hospital Charge Code	60632532
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

BASALJEL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632530
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

BASALJEL/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,325.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$3,617.25
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$2,719.50
Max. Negotiated Rate	$9,065.00
Rate for Payer: Aetna Commercial	$5,439.00
Rate for Payer: Aetna Medicare Advantage	$5,439.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,623.15
Rate for Payer: Cigna Commercial	$9,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$2,719.50
Max. Negotiated Rate	$4,387.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$2,572.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$2,572.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$3,617.25
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$3,507.75
Max. Negotiated Rate	$5,659.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$3,507.75
Max. Negotiated Rate	$11,692.50
Rate for Payer: Aetna Commercial	$7,015.50
Rate for Payer: Aetna Medicare Advantage	$7,015.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,963.18
Rate for Payer: Cigna Commercial	$11,692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$2,572.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges