Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUT ANCHR OSSIOFIB 4.75BLK TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700792
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

SUT ANCHR OSSIOFIB 4.75BLK TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700792
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

SUT ANCHR OSSIOFIB 4.75 SNARE

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270700794
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

SUT ANCHR OSSIOFIB 4.75 SNARE

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270700794
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,042.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

SUT DEXON/VICRYL/POLY4/0 V-20

Facility

$6.31

Hospital Charge Code	2709000693
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.15
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: Aetna Medicare Advantage	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.61
Rate for Payer: Cigna Commercial	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.82
Rate for Payer: Oxford Commercial	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$3.15

SUT DEXON/VICRYL/POLY4/0 V-20

Facility

$6.31

Hospital Charge Code	2709000693
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

SUT FOR FIB #2 W/NDL3910090021

Facility

$110.50

Hospital Charge Code	270641992
Hospital Revenue Code	272
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

SUT FOR FIB #2 W/NDL3910090021

Facility

$110.50

Hospital Charge Code	270641992
Hospital Revenue Code	272
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$55.25
Rate for Payer: Aetna Commercial	$33.15
Rate for Payer: Aetna Medicare Advantage	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.18
Rate for Payer: Cigna Commercial	$55.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.37
Rate for Payer: Oxford Commercial	$55.25
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$55.25

SUT GORE-TEX CV-7 TTC-07 D/A

Facility

$272.08

Hospital Charge Code	270650826
Hospital Revenue Code	272
Min. Negotiated Rate	$35.37
Max. Negotiated Rate	$136.04
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna Medicare Advantage	$81.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.38
Rate for Payer: Cigna Commercial	$136.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.37
Rate for Payer: Oxford Commercial	$136.04
Rate for Payer: Qualcare PPO/HMO/WC	$40.81
Rate for Payer: UnitedHealthcare Commercial	$136.04

SUT GORE-TEX CV-7 TTC-07 D/A

Facility

$272.08

Hospital Charge Code	270650826
Hospital Revenue Code	272
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$40.81

SUTH ANCHOR BIOCOMP P-LOCK

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687858
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SUTH ANCHOR BIOCOMP P-LOCK

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687858
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SUTRE LASSO 30DEG STR AR406830

Facility

$1,125.00

Hospital Charge Code	270640196
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

SUTRE LASSO 30DEG STR AR406830

Facility

$1,125.00

Hospital Charge Code	270640196
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.25
Rate for Payer: Oxford Commercial	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$562.50

SUTRELASSO HIP CRESCENT

Facility

$825.00

Hospital Charge Code	270677470
Hospital Revenue Code	272
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$412.50

SUTRELASSO HIP CRESCENT

Facility

$825.00

Hospital Charge Code	270677470
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP

Facility

$825.00

Hospital Charge Code	270681513
Hospital Revenue Code	272
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$412.50

SUTRLASSO FOR HIP

Facility

$825.00

Hospital Charge Code	270681513
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP 45DEG L

Facility

$825.00

Hospital Charge Code	270681512
Hospital Revenue Code	272
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$412.50

SUTRLASSO FOR HIP 45DEG L

Facility

$825.00

Hospital Charge Code	270681512
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP 45DEG R

Facility

$825.00

Hospital Charge Code	270681511
Hospital Revenue Code	272
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$412.50

SUTRLASSO FOR HIP 45DEG R

Facility

$825.00

Hospital Charge Code	270681511
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO HIP 90 STR

Facility

$825.00

Hospital Charge Code	270681514
Hospital Revenue Code	272
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$412.50

SUTRLASSO HIP 90 STR

Facility

$825.00

Hospital Charge Code	270681514
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTR ORTH BLUE WO/NEED 223111

Facility

$1,325.00

Hospital Charge Code	270635836
Hospital Revenue Code	272
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$198.75
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

Know your out-of-pocket cost for care.

All Charges