Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLAMP MEDIUM 6-POSITION WITH

Facility

$3,229.05

Hospital Charge Code	270644914
Hospital Revenue Code	272
Min. Negotiated Rate	$484.36
Max. Negotiated Rate	$484.36
Rate for Payer: Qualcare PPO/HMO/WC	$484.36

CLAMP MI ANGL VASTAT 2 1001533

Facility

$47.60

Hospital Charge Code	270626259
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$23.80
Rate for Payer: Aetna Commercial	$14.28
Rate for Payer: Aetna Medicare Advantage	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.14
Rate for Payer: Cigna Commercial	$23.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.19
Rate for Payer: Oxford Commercial	$23.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.14
Rate for Payer: UnitedHealthcare Commercial	$23.80

CLAMP MI ANGL VASTAT 2 1001533

Facility

$47.60

Hospital Charge Code	270626259
Hospital Revenue Code	272
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$7.14
Rate for Payer: Qualcare PPO/HMO/WC	$7.14

CLAMP MIXTER 8 1/4

Facility

$219.80

Hospital Charge Code	270689133
Hospital Revenue Code	272
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$109.90
Rate for Payer: Aetna Commercial	$65.94
Rate for Payer: Aetna Medicare Advantage	$65.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.05
Rate for Payer: Cigna Commercial	$109.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.57
Rate for Payer: Oxford Commercial	$109.90
Rate for Payer: Qualcare PPO/HMO/WC	$32.97
Rate for Payer: UnitedHealthcare Commercial	$109.90

CLAMP MIXTER 8 1/4

Facility

$219.80

Hospital Charge Code	270689133
Hospital Revenue Code	272
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$32.97
Rate for Payer: Qualcare PPO/HMO/WC	$32.97

CLAMP MONOTUBE RED 51503175

Facility

$4,300.00

Hospital Charge Code	270643409
Hospital Revenue Code	272
Min. Negotiated Rate	$645.00
Max. Negotiated Rate	$645.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00

CLAMP MONOTUBE RED 51503175

Facility

$4,300.00

Hospital Charge Code	270643409
Hospital Revenue Code	272
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$2,150.00
Rate for Payer: Aetna Commercial	$1,290.00
Rate for Payer: Aetna Medicare Advantage	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,096.50
Rate for Payer: Cigna Commercial	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.00
Rate for Payer: Oxford Commercial	$2,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00
Rate for Payer: UnitedHealthcare Commercial	$2,150.00

CLAMP MRI 5-HOLE 4921-2-020

Facility

$3,885.00

Hospital Charge Code	270643439
Hospital Revenue Code	272
Min. Negotiated Rate	$505.05
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,165.50
Rate for Payer: Aetna Medicare Advantage	$1,165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$990.67
Rate for Payer: Cigna Commercial	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$505.05
Rate for Payer: Oxford Commercial	$1,942.50
Rate for Payer: Qualcare PPO/HMO/WC	$582.75
Rate for Payer: UnitedHealthcare Commercial	$1,942.50

CLAMP MRI 5-HOLE 4921-2-020

Facility

$3,885.00

Hospital Charge Code	270643439
Hospital Revenue Code	272
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$582.75
Rate for Payer: Qualcare PPO/HMO/WC	$582.75

CLAMP MULTI-PIN LARGE

Facility

$2,000.00

Service Code	HCPCS A4649
Hospital Charge Code	270699855
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CLAMP MULTI-PIN LARGE

Facility

$2,000.00

Service Code	HCPCS A4649
Hospital Charge Code	270699855
Hospital Revenue Code	272
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00

CLAMP OPEN

Facility

$1,109.30

Service Code	HCPCS C1713
Hospital Charge Code	270639890
Hospital Revenue Code	278
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$268.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.45
Rate for Payer: Qualcare PPO/HMO/WC	$166.40

CLAMP OPEN

Facility

$1,109.30

Service Code	HCPCS C1713
Hospital Charge Code	270639890
Hospital Revenue Code	278
Min. Negotiated Rate	$166.40
Max. Negotiated Rate	$554.65
Rate for Payer: Aetna Commercial	$332.79
Rate for Payer: Aetna Medicare Advantage	$332.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.87
Rate for Payer: Cigna Commercial	$554.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.45
Rate for Payer: Qualcare PPO/HMO/WC	$166.40

CLAMP OPEN ADJUSTBL MED

Facility

$1,965.00

Hospital Charge Code	270676712
Hospital Revenue Code	272
Min. Negotiated Rate	$294.75
Max. Negotiated Rate	$294.75
Rate for Payer: Qualcare PPO/HMO/WC	$294.75

CLAMP OPEN ADJUSTBL MED

Facility

$1,965.00

Hospital Charge Code	270676712
Hospital Revenue Code	272
Min. Negotiated Rate	$255.45
Max. Negotiated Rate	$982.50
Rate for Payer: Aetna Commercial	$589.50
Rate for Payer: Aetna Medicare Advantage	$589.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.07
Rate for Payer: Cigna Commercial	$982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.45
Rate for Payer: Oxford Commercial	$982.50
Rate for Payer: Qualcare PPO/HMO/WC	$294.75
Rate for Payer: UnitedHealthcare Commercial	$982.50

CLAMP OSTOMY POUCH

Facility

$5.82

Hospital Charge Code	270649910
Hospital Revenue Code	270
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.91
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.91

CLAMP OSTOMY POUCH

Facility

$5.82

Hospital Charge Code	270649910
Hospital Revenue Code	270
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CLAMP OUTLET PORT 5C4170

Facility

$44.85

Hospital Charge Code	270607858
Hospital Revenue Code	272
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$22.43
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.44
Rate for Payer: Cigna Commercial	$22.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.83
Rate for Payer: Oxford Commercial	$22.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.73
Rate for Payer: UnitedHealthcare Commercial	$22.43

CLAMP OUTLET PORT 5C4170

Facility

$44.85

Hospital Charge Code	270607858
Hospital Revenue Code	272
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.73

CLAMP PENILE CUNNINGHAM 004054

Facility

$120.95

Hospital Charge Code	270633278
Hospital Revenue Code	272
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$18.14
Rate for Payer: Qualcare PPO/HMO/WC	$18.14

CLAMP PENILE CUNNINGHAM 004054

Facility

$120.95

Hospital Charge Code	270633278
Hospital Revenue Code	272
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$60.48
Rate for Payer: Aetna Commercial	$36.28
Rate for Payer: Aetna Medicare Advantage	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.84
Rate for Payer: Cigna Commercial	$60.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.72
Rate for Payer: Oxford Commercial	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$18.14
Rate for Payer: UnitedHealthcare Commercial	$60.48

CLAMP PIN 5 HOLE W/ 11MM POST

Facility

$3,833.30

Hospital Charge Code	270674578
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$927.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.66
Rate for Payer: Qualcare PPO/HMO/WC	$575.00

CLAMP PIN 5 HOLE W/ 11MM POST

Facility

$3,833.30

Hospital Charge Code	270674578
Hospital Revenue Code	278
Min. Negotiated Rate	$575.00
Max. Negotiated Rate	$1,916.65
Rate for Payer: Aetna Commercial	$1,149.99
Rate for Payer: Aetna Medicare Advantage	$1,149.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$977.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$977.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$977.49
Rate for Payer: Cigna Commercial	$1,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$927.66
Rate for Payer: Qualcare PPO/HMO/WC	$575.00

CLAMP PIN LENGTHENER MICRO HI

Facility

$7,889.20

Hospital Charge Code	270688787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,025.60
Max. Negotiated Rate	$3,944.60
Rate for Payer: Aetna Commercial	$2,366.76
Rate for Payer: Aetna Medicare Advantage	$2,366.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,011.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,011.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,011.75
Rate for Payer: Cigna Commercial	$3,944.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,025.60
Rate for Payer: Oxford Commercial	$3,944.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.38
Rate for Payer: UnitedHealthcare Commercial	$3,944.60

CLAMP PIN LENGTHENER MICRO HI

Facility

$7,889.20

Hospital Charge Code	270688787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,183.38
Max. Negotiated Rate	$1,183.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.38

Know your out-of-pocket cost for care.

All Charges