Heights University Hospital

All Charges

Charge

Type

Setting

Price

BLADE XTRACT FULL 62MM

Facility

$3,420.00

Service Code	HCPCS A4649
Hospital Charge Code	270697340
Hospital Revenue Code	272
Min. Negotiated Rate	$513.00
Max. Negotiated Rate	$513.00
Rate for Payer: Qualcare PPO/HMO/WC	$513.00

BLADE XTRACT FULL 62MM

Facility

$3,420.00

Service Code	HCPCS A4649
Hospital Charge Code	270697340
Hospital Revenue Code	272
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$1,710.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.10
Rate for Payer: Cigna Commercial	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.60
Rate for Payer: Oxford Commercial	$1,710.00
Rate for Payer: Qualcare PPO/HMO/WC	$513.00
Rate for Payer: UnitedHealthcare Commercial	$1,710.00

BLADE XTRACT TRUNC 62MM

Facility

$3,420.00

Service Code	HCPCS A4649
Hospital Charge Code	270697339
Hospital Revenue Code	272
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$1,710.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.10
Rate for Payer: Cigna Commercial	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.60
Rate for Payer: Oxford Commercial	$1,710.00
Rate for Payer: Qualcare PPO/HMO/WC	$513.00
Rate for Payer: UnitedHealthcare Commercial	$1,710.00

BLADE XTRACT TRUNC 62MM

Facility

$3,420.00

Service Code	HCPCS A4649
Hospital Charge Code	270697339
Hospital Revenue Code	272
Min. Negotiated Rate	$513.00
Max. Negotiated Rate	$513.00
Rate for Payer: Qualcare PPO/HMO/WC	$513.00

BLADE ZIM 19.5/86/1.27 5071-20

Facility

$558.45

Hospital Charge Code	270606468
Hospital Revenue Code	272
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$279.23
Rate for Payer: Aetna Commercial	$167.53
Rate for Payer: Aetna Medicare Advantage	$167.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.40
Rate for Payer: Cigna Commercial	$279.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Oxford Commercial	$279.23
Rate for Payer: Qualcare PPO/HMO/WC	$83.77
Rate for Payer: UnitedHealthcare Commercial	$279.23

BLADE ZIM 19.5/86/1.27 5071-20

Facility

$558.45

Hospital Charge Code	270606468
Hospital Revenue Code	272
Min. Negotiated Rate	$83.77
Max. Negotiated Rate	$83.77
Rate for Payer: Qualcare PPO/HMO/WC	$83.77

BLADE ZIM 6.5/25.5MM 5023-232

Facility

$46.35

Hospital Charge Code	270601042
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

BLADE ZIM 6.5/25.5MM 5023-232

Facility

$46.35

Hospital Charge Code	270601042
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$23.18
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.82
Rate for Payer: Cigna Commercial	$23.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$23.18

BLADE ZIM 9.5/25.5MM 5023-238

Facility

$46.35

Hospital Charge Code	270601048
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

BLADE ZIM 9.5/25.5MM 5023-238

Facility

$46.35

Hospital Charge Code	270601048
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$23.18
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.82
Rate for Payer: Cigna Commercial	$23.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$23.18

BLADE ZIM BRZ TOT KNE 5052-279

Facility

$246.45

Hospital Charge Code	270601049
Hospital Revenue Code	272
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$123.22
Rate for Payer: Aetna Commercial	$73.94
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.04
Rate for Payer: Oxford Commercial	$123.22
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$123.22

BLADE ZIM BRZ TOT KNE 5052-279

Facility

$246.45

Hospital Charge Code	270601049
Hospital Revenue Code	272
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

BLADE ZIM ME92 RIBBED 5071-595

Facility

$380.00

Hospital Charge Code	270601061
Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00

BLADE ZIM ME92 RIBBED 5071-595

Facility

$380.00

Hospital Charge Code	270601061
Hospital Revenue Code	272
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.90
Rate for Payer: Cigna Commercial	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.00
Rate for Payer: UnitedHealthcare Commercial	$190.00

BLADE ZIM NXG PATELLA 51209541

Facility

$272.85

Hospital Charge Code	270617626
Hospital Revenue Code	272
Min. Negotiated Rate	$35.47
Max. Negotiated Rate	$136.43
Rate for Payer: Aetna Commercial	$81.86
Rate for Payer: Aetna Medicare Advantage	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.58
Rate for Payer: Cigna Commercial	$136.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.47
Rate for Payer: Oxford Commercial	$136.43
Rate for Payer: Qualcare PPO/HMO/WC	$40.93
Rate for Payer: UnitedHealthcare Commercial	$136.43

BLADE ZIM NXG PATELLA 51209541

Facility

$272.85

Hospital Charge Code	270617626
Hospital Revenue Code	272
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$40.93
Rate for Payer: Qualcare PPO/HMO/WC	$40.93

BLADE ZIM OSCIL CRES 5023-170

Facility

$598.45

Hospital Charge Code	270610639
Hospital Revenue Code	272
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$299.23
Rate for Payer: Aetna Commercial	$179.53
Rate for Payer: Aetna Medicare Advantage	$179.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.60
Rate for Payer: Cigna Commercial	$299.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.80
Rate for Payer: Oxford Commercial	$299.23
Rate for Payer: Qualcare PPO/HMO/WC	$89.77
Rate for Payer: UnitedHealthcare Commercial	$299.23

BLADE ZIM OSCIL CRES 5023-170

Facility

$598.45

Hospital Charge Code	270610639
Hospital Revenue Code	272
Min. Negotiated Rate	$89.77
Max. Negotiated Rate	$89.77
Rate for Payer: Qualcare PPO/HMO/WC	$89.77

BLADE ZIM OSCIL CRES 5023-171

Facility

$573.65

Hospital Charge Code	270610642
Hospital Revenue Code	272
Min. Negotiated Rate	$74.57
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$172.09
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.57
Rate for Payer: Oxford Commercial	$286.82
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$286.82

BLADE ZIM OSCIL CRES 5023-171

Facility

$573.65

Hospital Charge Code	270610642
Hospital Revenue Code	272
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

BLADE ZIM OSCIL CRES 5023-172

Facility

$598.45

Hospital Charge Code	270610643
Hospital Revenue Code	272
Min. Negotiated Rate	$89.77
Max. Negotiated Rate	$89.77
Rate for Payer: Qualcare PPO/HMO/WC	$89.77

BLADE ZIM OSCIL CRES 5023-172

Facility

$598.45

Hospital Charge Code	270610643
Hospital Revenue Code	272
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$299.23
Rate for Payer: Aetna Commercial	$179.53
Rate for Payer: Aetna Medicare Advantage	$179.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.60
Rate for Payer: Cigna Commercial	$299.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.80
Rate for Payer: Oxford Commercial	$299.23
Rate for Payer: Qualcare PPO/HMO/WC	$89.77
Rate for Payer: UnitedHealthcare Commercial	$299.23

BLADE ZIM OSCIL CRES 5023-176

Facility

$598.45

Hospital Charge Code	270610646
Hospital Revenue Code	272
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$299.23
Rate for Payer: Aetna Commercial	$179.53
Rate for Payer: Aetna Medicare Advantage	$179.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.60
Rate for Payer: Cigna Commercial	$299.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.80
Rate for Payer: Oxford Commercial	$299.23
Rate for Payer: Qualcare PPO/HMO/WC	$89.77
Rate for Payer: UnitedHealthcare Commercial	$299.23

BLADE ZIM OSCIL CRES 5023-176

Facility

$598.45

Hospital Charge Code	270610646
Hospital Revenue Code	272
Min. Negotiated Rate	$89.77
Max. Negotiated Rate	$89.77
Rate for Payer: Qualcare PPO/HMO/WC	$89.77

BLADE ZIM OSCIL LG BN 5052-572

Facility

$170.45

Hospital Charge Code	270601047
Hospital Revenue Code	272
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$85.22
Rate for Payer: Aetna Commercial	$51.13
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$85.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.16
Rate for Payer: Oxford Commercial	$85.22
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$85.22

Know your out-of-pocket cost for care.

All Charges