Heights University Hospital

All Charges

Charge

Type

Setting

Price

SWIVELOCK 4.75MM W/TIGER TAPE

Facility

$3,360.00

Hospital Charge Code	270666758
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: Qualcare PPO/HMO/WC	$504.00

SWIVELOCK 9MM TENODESIS SUTURE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664268
Hospital Revenue Code	278
Min. Negotiated Rate	$434.25
Max. Negotiated Rate	$700.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$579.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$700.59
Rate for Payer: Qualcare PPO/HMO/WC	$434.25

SWIVELOCK 9MM TENODESIS SUTURE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664268
Hospital Revenue Code	278
Min. Negotiated Rate	$434.25
Max. Negotiated Rate	$1,447.50
Rate for Payer: Aetna Commercial	$868.50
Rate for Payer: Aetna Medicare Advantage	$868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$579.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$738.23
Rate for Payer: Cigna Commercial	$1,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$700.59
Rate for Payer: Qualcare PPO/HMO/WC	$434.25

SWIVELOCK BIO-COMP 4.75x24.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270676559
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK BIO-COMP 4.75x24.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270676559
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK BIO-COMP DBL 4.75x19

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270675920
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

SWIVELOCK BIO-COMP DBL 4.75x19

Facility

$2,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270675920
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$630.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$412.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$960.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$382.39
Max. Negotiated Rate	$616.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.39

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$382.39
Max. Negotiated Rate	$1,274.62
Rate for Payer: Aetna Commercial	$764.77
Rate for Payer: Aetna Medicare Advantage	$764.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.06
Rate for Payer: Cigna Commercial	$1,274.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.39

SWIVELOCK MINI 3.5x8.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270677960
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK MINI 3.5x8.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270677960
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$637.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK NANO DISP KIT

Facility

$1,475.00

Hospital Charge Code	270691848
Hospital Revenue Code	272
Min. Negotiated Rate	$191.75
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.75
Rate for Payer: Oxford Commercial	$737.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$737.50

SWIVELOCK NANO DISP KIT

Facility

$1,475.00

Hospital Charge Code	270691848
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

Know your out-of-pocket cost for care.

All Charges