Heights University Hospital

All Charges

Charge

Type

Setting

Price

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

BOJRAB ALT PLS HAMD ER IMP 625

Facility

$1,790.00

Hospital Charge Code	270639214
Hospital Revenue Code	272
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$895.00
Rate for Payer: Aetna Commercial	$537.00
Rate for Payer: Aetna Medicare Advantage	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$456.45
Rate for Payer: Cigna Commercial	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.70
Rate for Payer: Oxford Commercial	$895.00
Rate for Payer: Qualcare PPO/HMO/WC	$268.50
Rate for Payer: UnitedHealthcare Commercial	$895.00

BOJRAB ALT PLS HAMD ER IMP 625

Facility

$1,790.00

Hospital Charge Code	270639214
Hospital Revenue Code	272
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$268.50
Rate for Payer: Qualcare PPO/HMO/WC	$268.50

BOJRAB PTL A MID EAR IMPLT 675

Facility

$1,790.00

Hospital Charge Code	270639215
Hospital Revenue Code	278
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$895.00
Rate for Payer: Aetna Commercial	$537.00
Rate for Payer: Aetna Medicare Advantage	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$456.45
Rate for Payer: Cigna Commercial	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.18
Rate for Payer: Qualcare PPO/HMO/WC	$268.50

BOJRAB PTL A MID EAR IMPLT 675

Facility

$1,790.00

Hospital Charge Code	270639215
Hospital Revenue Code	278
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$433.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.18
Rate for Payer: Qualcare PPO/HMO/WC	$268.50

BOJRAB UNIV PROST MID EAR 606

Facility

$2,100.00

Hospital Charge Code	270641524
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

BOJRAB UNIV PROST MID EAR 606

Facility

$2,100.00

Hospital Charge Code	270641524
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

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$915.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$1,892.50
Rate for Payer: Aetna Commercial	$1,135.50
Rate for Payer: Aetna Medicare Advantage	$1,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$965.17
Rate for Payer: Cigna Commercial	$1,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

BOLSTER ETH SUTURE RETENT 450G

Facility

$14.45

Hospital Charge Code	270616314
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

BOLSTER ETH SUTURE RETENT 450G

Facility

$14.45

Hospital Charge Code	270616314
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$7.22
Rate for Payer: Aetna Commercial	$4.33
Rate for Payer: Aetna Medicare Advantage	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.68
Rate for Payer: Cigna Commercial	$7.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.88
Rate for Payer: Oxford Commercial	$7.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$7.22

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.08
Max. Negotiated Rate	$2,458.50
Rate for Payer: Aetna Commercial	$2,458.50
Rate for Payer: Aetna Medicare Advantage	$2,458.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,089.72
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$1,983.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$805.00
Rate for Payer: Aetna Commercial	$483.00
Rate for Payer: Aetna Medicare Advantage	$483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.55
Rate for Payer: Cigna Commercial	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$389.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,537.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5X25MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705888
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,537.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5X25MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705888
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5 X30MM

Facility

$5,210.00

Hospital Charge Code	270703005
Hospital Revenue Code	278
Min. Negotiated Rate	$781.50
Max. Negotiated Rate	$1,260.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.82
Rate for Payer: Qualcare PPO/HMO/WC	$781.50

BOLT 8.5 X30MM

Facility

$5,210.00

Hospital Charge Code	270703005
Hospital Revenue Code	278
Min. Negotiated Rate	$781.50
Max. Negotiated Rate	$2,605.00
Rate for Payer: Aetna Commercial	$1,563.00
Rate for Payer: Aetna Medicare Advantage	$1,563.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.55
Rate for Payer: Cigna Commercial	$2,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.82
Rate for Payer: Qualcare PPO/HMO/WC	$781.50

BOLT BMT TRANS 5 60 33-345462

Facility

$944.85

Hospital Charge Code	270618209
Hospital Revenue Code	278
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$472.43
Rate for Payer: Aetna Commercial	$283.45
Rate for Payer: Aetna Medicare Advantage	$283.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.94
Rate for Payer: Cigna Commercial	$472.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: Qualcare PPO/HMO/WC	$141.73

BOLT BMT TRANS 5 60 33-345462

Facility

$944.85

Hospital Charge Code	270618209
Hospital Revenue Code	278
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$228.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: Qualcare PPO/HMO/WC	$141.73

BOLT BMT TRANS 5 70 33-345464

Facility

$944.85

Hospital Charge Code	270618210
Hospital Revenue Code	278
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$228.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: Qualcare PPO/HMO/WC	$141.73

Know your out-of-pocket cost for care.

All Charges