Heights University Hospital

All Charges

Charge

Type

Setting

Price

BIOLOX MOD CERAMIC HEAD36MM

Facility

$1,949.00

Service Code	HCPCS C1713
Hospital Charge Code	270702515
Hospital Revenue Code	278
Min. Negotiated Rate	$292.35
Max. Negotiated Rate	$974.50
Rate for Payer: Aetna Commercial	$584.70
Rate for Payer: Aetna Medicare Advantage	$584.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.00
Rate for Payer: Cigna Commercial	$974.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.66
Rate for Payer: Qualcare PPO/HMO/WC	$292.35

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$899.25
Max. Negotiated Rate	$2,997.50
Rate for Payer: Aetna Commercial	$1,798.50
Rate for Payer: Aetna Medicare Advantage	$1,798.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,528.72
Rate for Payer: Cigna Commercial	$2,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: Qualcare PPO/HMO/WC	$899.25

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$899.25
Max. Negotiated Rate	$1,450.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: Qualcare PPO/HMO/WC	$899.25

BIOMESH CLLGN 8cmX12cm 481812

Facility

$5,828.00

Hospital Charge Code	270635508
Hospital Revenue Code	278
Min. Negotiated Rate	$874.20
Max. Negotiated Rate	$1,410.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.38
Rate for Payer: Qualcare PPO/HMO/WC	$874.20

BIOMESH CLLGN 8cmX12cm 481812

Facility

$5,828.00

Hospital Charge Code	270635508
Hospital Revenue Code	278
Min. Negotiated Rate	$874.20
Max. Negotiated Rate	$2,914.00
Rate for Payer: Aetna Commercial	$1,748.40
Rate for Payer: Aetna Medicare Advantage	$1,748.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,486.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,486.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,486.14
Rate for Payer: Cigna Commercial	$2,914.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.38
Rate for Payer: Qualcare PPO/HMO/WC	$874.20

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$207.00
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$2,520.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$5,208.32
Rate for Payer: Aetna Commercial	$3,124.99
Rate for Payer: Aetna Medicare Advantage	$3,124.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.25
Rate for Payer: Cigna Commercial	$5,208.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$3,426.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$7,080.00
Rate for Payer: Aetna Commercial	$4,248.00
Rate for Payer: Aetna Medicare Advantage	$4,248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,610.80
Rate for Payer: Cigna Commercial	$7,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BIOMET TIB BLOCK 10MM 71

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270690778
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

BIOMET TIB BLOCK 10MM 71

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270690778
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$1,665.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

BIO NDLE FRANSEEN LNG 20G15CM

Facility

$24.35

Hospital Charge Code	270658326
Hospital Revenue Code	272
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$12.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$12.18

BIO NDLE FRANSEEN LNG 20G15CM

Facility

$24.35

Hospital Charge Code	270658326
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

BIOPATCH BLUE 1 IN DISK W/7MM

Facility

$34.98

Hospital Charge Code	270671184
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

BIOPATCH BLUE 1 IN DISK W/7MM

Facility

$34.98

Hospital Charge Code	270671184
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.49

BioPatch protective disk 4.0mm

Facility

$53.80

Hospital Charge Code	6063943324
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

BioPatch protective disk 4.0mm

Facility

$53.80

Hospital Charge Code	6063943324
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

BioPatch protective disk 7.0mm

Facility

$54.35

Hospital Charge Code	6063943325
Hospital Revenue Code	250
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$27.18
Rate for Payer: Aetna Commercial	$16.30
Rate for Payer: Aetna Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.86
Rate for Payer: Cigna Commercial	$27.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.07
Rate for Payer: Oxford Commercial	$27.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.15
Rate for Payer: UnitedHealthcare Commercial	$27.18

BioPatch protective disk 7.0mm

Facility

$54.35

Hospital Charge Code	6063943325
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$8.15
Rate for Payer: Qualcare PPO/HMO/WC	$8.15

BIOPINCE DIP AUTOBIOPSY18GX15C

Facility

$260.00

Hospital Charge Code	270658282
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

BIOPINCE DIP AUTOBIOPSY18GX15C

Facility

$260.00

Hospital Charge Code	270658282
Hospital Revenue Code	272
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$130.00

Know your out-of-pocket cost for care.

All Charges