Heights University Hospital

All Charges

Charge

Type

Setting

Price

BOOKLETS, CRUTCHES, WALKERS &

Facility

$10.00

Hospital Charge Code	270665586
Hospital Revenue Code	270
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

BOOKLET YOUR BABY 1ST WKS

Facility

$19.25

Hospital Charge Code	270600488
Hospital Revenue Code	270
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

BOOKLET YOUR BABY 1ST WKS

Facility

$19.25

Hospital Charge Code	270600488
Hospital Revenue Code	270
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

BOOST BAR

Facility

$5.00

Hospital Charge Code	60635263
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BOOST BAR

Facility

$5.00

Hospital Charge Code	60635263
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

BOOST CONNECT TISS IMPL 2.0CC

Facility

$10,995.00

Service Code	HCPCS C1763
Hospital Charge Code	270697378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,649.25
Max. Negotiated Rate	$2,660.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,660.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,649.25

BOOST CONNECT TISS IMPL 2.0CC

Facility

$10,995.00

Service Code	HCPCS C1763
Hospital Charge Code	270697378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,649.25
Max. Negotiated Rate	$5,497.50
Rate for Payer: Cigna Commercial	$5,497.50
Rate for Payer: Aetna Commercial	$3,298.50
Rate for Payer: Aetna Medicare Advantage	$3,298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,803.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,803.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,803.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,660.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,649.25

BOOST HEAD POSITIONER

Facility

$60.00

Hospital Charge Code	270658160
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$30.00

BOOST HEAD POSITIONER

Facility

$60.00

Hospital Charge Code	270658160
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

BOOSTRIX SDV 0.5 ML

Facility

$295.47

Service Code	HCPCS 90715
Hospital Charge Code	60630104
Hospital Revenue Code	636
Min. Negotiated Rate	$44.32
Max. Negotiated Rate	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$44.32

BOOSTRIX SDV 0.5 ML

Facility

$295.47

Service Code	HCPCS 90715
Hospital Charge Code	60630104
Hospital Revenue Code	636
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$88.64
Rate for Payer: Aetna Commercial	$88.64
Rate for Payer: Aetna Medicare Advantage	$88.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.34
Rate for Payer: Cigna Commercial	$39.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$44.32

BOOSTRIX SDV EX

Facility

$298.89

Service Code	NDC 58160084252
Hospital Charge Code	60630104EX
Hospital Revenue Code	259
Min. Negotiated Rate	$44.83
Max. Negotiated Rate	$44.83
Rate for Payer: Qualcare PPO/HMO/WC	$44.83

BOOSTRIX SDV EX

Facility

$298.89

Service Code	NDC 58160084252
Hospital Charge Code	60630104EX
Hospital Revenue Code	259
Min. Negotiated Rate	$38.86
Max. Negotiated Rate	$149.44
Rate for Payer: Aetna Commercial	$89.67
Rate for Payer: Aetna Medicare Advantage	$89.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.22
Rate for Payer: Cigna Commercial	$149.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.86
Rate for Payer: Oxford Commercial	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$44.83
Rate for Payer: UnitedHealthcare Commercial	$149.44

BOOT ANKLE MULTI MD 603404302C

Facility

$219.65

Hospital Charge Code	270302900
Hospital Revenue Code	274
Min. Negotiated Rate	$32.95
Max. Negotiated Rate	$109.83
Rate for Payer: Aetna Commercial	$65.89
Rate for Payer: Aetna Medicare Advantage	$65.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.01
Rate for Payer: Cigna Commercial	$109.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.16
Rate for Payer: Qualcare PPO/HMO/WC	$32.95

BOOT ANKLE MULTI MD 603404302C

Facility

$219.65

Hospital Charge Code	270302900
Hospital Revenue Code	274
Min. Negotiated Rate	$32.95
Max. Negotiated Rate	$53.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.16
Rate for Payer: Qualcare PPO/HMO/WC	$32.95

BOOT ANKLE MULT XLG 603404302E

Facility

$231.75

Hospital Charge Code	270302910
Hospital Revenue Code	274
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$56.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.08
Rate for Payer: Qualcare PPO/HMO/WC	$34.76

BOOT ANKLE MULT XLG 603404302E

Facility

$231.75

Hospital Charge Code	270302910
Hospital Revenue Code	274
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$115.88
Rate for Payer: Aetna Commercial	$69.53
Rate for Payer: Aetna Medicare Advantage	$69.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.10
Rate for Payer: Cigna Commercial	$115.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.08
Rate for Payer: Qualcare PPO/HMO/WC	$34.76

BOOT BUCKS TRACT UNIVE 109005C

Facility

$299.75

Hospital Charge Code	270639707
Hospital Revenue Code	270
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$44.96
Rate for Payer: Qualcare PPO/HMO/WC	$44.96

BOOT BUCKS TRACT UNIVE 109005C

Facility

$299.75

Hospital Charge Code	270639707
Hospital Revenue Code	270
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$149.88
Rate for Payer: Aetna Commercial	$89.92
Rate for Payer: Aetna Medicare Advantage	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.44
Rate for Payer: Cigna Commercial	$149.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.97
Rate for Payer: Oxford Commercial	$149.88
Rate for Payer: Qualcare PPO/HMO/WC	$44.96
Rate for Payer: UnitedHealthcare Commercial	$149.88

BOOT CAMWALKER

Facility

$5.00

Hospital Charge Code	270633897
Hospital Revenue Code	271
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

BOOT CAMWALKER

Facility

$5.00

Hospital Charge Code	270633897
Hospital Revenue Code	271
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BOOT HEEL LIFT SUSPENSION 9949

Facility

$229.90

Hospital Charge Code	270302935
Hospital Revenue Code	272
Min. Negotiated Rate	$29.89
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Commercial	$68.97
Rate for Payer: Aetna Medicare Advantage	$68.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.62
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.89
Rate for Payer: Oxford Commercial	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.48
Rate for Payer: UnitedHealthcare Commercial	$114.95

BOOT HEEL LIFT SUSPENSION 9949

Facility

$229.90

Hospital Charge Code	270302935
Hospital Revenue Code	272
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$34.48
Rate for Payer: Qualcare PPO/HMO/WC	$34.48

BOOTIES SUTURE AID YELL 30-702

Facility

$5.78

Hospital Charge Code	270646080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.89

BOOTIES SUTURE AID YELL 30-702

Facility

$5.78

Hospital Charge Code	270646080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

Know your out-of-pocket cost for care.

All Charges