Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
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

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
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

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
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

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
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

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
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

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
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

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$49.22
Rate for Payer: Qualcare PPO/HMO/WC	$49.22

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$164.07
Rate for Payer: Aetna Commercial	$98.44
Rate for Payer: Aetna Medicare Advantage	$98.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.68
Rate for Payer: Cigna Commercial	$164.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.66
Rate for Payer: Oxford Commercial	$164.07
Rate for Payer: Qualcare PPO/HMO/WC	$49.22
Rate for Payer: UnitedHealthcare Commercial	$164.07

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HSG

Facility

$56.65

Hospital Charge Code	270654141
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$28.32
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.36
Rate for Payer: Oxford Commercial	$28.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$28.32

TRAY HSG

Facility

$56.65

Hospital Charge Code	270654141
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

TRAY HSG

Facility

$506.00

Hospital Charge Code	270655987
Hospital Revenue Code	272
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$75.90

TRAY HSG

Facility

$506.00

Hospital Charge Code	270655987
Hospital Revenue Code	272
Min. Negotiated Rate	$65.78
Max. Negotiated Rate	$253.00
Rate for Payer: Aetna Commercial	$151.80
Rate for Payer: Aetna Medicare Advantage	$151.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.03
Rate for Payer: Cigna Commercial	$253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.78
Rate for Payer: Oxford Commercial	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.90
Rate for Payer: UnitedHealthcare Commercial	$253.00

TRAY HUMERAL REVERSE EXT 6MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$2,922.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

TRAY HUMERAL REVERSE EXT 6MM

Facility

$12,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270700196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,811.25
Max. Negotiated Rate	$6,037.50
Rate for Payer: Aetna Commercial	$3,622.50
Rate for Payer: Aetna Medicare Advantage	$3,622.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,079.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,079.12
Rate for Payer: Cigna Commercial	$6,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,922.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,811.25

TRAY HUMERAL STD PLUS 10 40MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694049
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TRAY HUMERAL STD PLUS 10 40MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694049
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TRAY HYSTSALPGRAM DISP 6050T

Facility

$173.65

Hospital Charge Code	270607963
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

TRAY HYSTSALPGRAM DISP 6050T

Facility

$173.65

Hospital Charge Code	270607963
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.57
Rate for Payer: Oxford Commercial	$86.83
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$86.83

TRAY INSTRUMENTS POLYVAC CRANO

Facility

$1,699.35

Hospital Charge Code	270684905
Hospital Revenue Code	272
Min. Negotiated Rate	$254.90
Max. Negotiated Rate	$254.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.90

TRAY INSTRUMENTS POLYVAC CRANO

Facility

$1,699.35

Hospital Charge Code	270684905
Hospital Revenue Code	272
Min. Negotiated Rate	$220.92
Max. Negotiated Rate	$849.67
Rate for Payer: Aetna Commercial	$509.81
Rate for Payer: Aetna Medicare Advantage	$509.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.33
Rate for Payer: Cigna Commercial	$849.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.92
Rate for Payer: Oxford Commercial	$849.67
Rate for Payer: Qualcare PPO/HMO/WC	$254.90
Rate for Payer: UnitedHealthcare Commercial	$849.67

TRAY INTRO PERCUTANEOUS

Facility

$269.04

Hospital Charge Code	270110051
Hospital Revenue Code	272
Min. Negotiated Rate	$34.98
Max. Negotiated Rate	$134.52
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	$68.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.61
Rate for Payer: Cigna Commercial	$134.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.98
Rate for Payer: Oxford Commercial	$134.52
Rate for Payer: Qualcare PPO/HMO/WC	$40.36
Rate for Payer: UnitedHealthcare Commercial	$134.52

Know your out-of-pocket cost for care.

All Charges