Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLIOQUINOL OINT 3% 28 GM

Facility

$48.00

Hospital Charge Code	6001242
Hospital Revenue Code	252
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

CLIOQUINOL OINT 3% 28 GM

Facility

$48.00

Hospital Charge Code	6001242
Hospital Revenue Code	252
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

CLIP

Facility

$1,250.00

Hospital Charge Code	270704026
Hospital Revenue Code	272
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$625.00

CLIP

Facility

$1,250.00

Hospital Charge Code	270704026
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$100.00

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$4,200.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,820.00
Rate for Payer: Oxford Commercial	$7,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$7,000.00

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$368.06
Rate for Payer: Aetna Commercial	$220.84
Rate for Payer: Aetna Medicare Advantage	$220.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.71
Rate for Payer: Cigna Commercial	$368.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.70
Rate for Payer: Oxford Commercial	$368.06
Rate for Payer: Qualcare PPO/HMO/WC	$110.42
Rate for Payer: UnitedHealthcare Commercial	$368.06

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$110.42
Max. Negotiated Rate	$110.42
Rate for Payer: Qualcare PPO/HMO/WC	$110.42

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$142.64
Rate for Payer: Qualcare PPO/HMO/WC	$142.64

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$123.53

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$123.62
Max. Negotiated Rate	$475.48
Rate for Payer: Aetna Commercial	$285.29
Rate for Payer: Aetna Medicare Advantage	$285.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.49
Rate for Payer: Cigna Commercial	$475.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.62
Rate for Payer: Oxford Commercial	$475.48
Rate for Payer: Qualcare PPO/HMO/WC	$142.64
Rate for Payer: UnitedHealthcare Commercial	$475.48

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$107.06
Max. Negotiated Rate	$411.76
Rate for Payer: Aetna Commercial	$247.06
Rate for Payer: Aetna Medicare Advantage	$247.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.00
Rate for Payer: Cigna Commercial	$411.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.06
Rate for Payer: Oxford Commercial	$411.76
Rate for Payer: Qualcare PPO/HMO/WC	$123.53
Rate for Payer: UnitedHealthcare Commercial	$411.76

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$194.97
Rate for Payer: Aetna Commercial	$116.98
Rate for Payer: Aetna Medicare Advantage	$116.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.44
Rate for Payer: Cigna Commercial	$194.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.69
Rate for Payer: Oxford Commercial	$194.97
Rate for Payer: Qualcare PPO/HMO/WC	$58.49
Rate for Payer: UnitedHealthcare Commercial	$194.97

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$58.49
Max. Negotiated Rate	$58.49
Rate for Payer: Qualcare PPO/HMO/WC	$58.49

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$1,549.35
Max. Negotiated Rate	$1,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$1,342.77
Max. Negotiated Rate	$5,164.50
Rate for Payer: Aetna Commercial	$3,098.70
Rate for Payer: Aetna Medicare Advantage	$3,098.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,633.89
Rate for Payer: Cigna Commercial	$5,164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,342.77
Rate for Payer: Oxford Commercial	$5,164.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35
Rate for Payer: UnitedHealthcare Commercial	$5,164.50

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$591.75
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$512.85
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,183.50
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.85
Rate for Payer: Oxford Commercial	$1,972.50
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Commercial	$1,972.50

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$126.97
Max. Negotiated Rate	$126.97
Rate for Payer: Qualcare PPO/HMO/WC	$126.97

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$423.25
Rate for Payer: Aetna Commercial	$253.95
Rate for Payer: Aetna Medicare Advantage	$253.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.86
Rate for Payer: Cigna Commercial	$423.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.05
Rate for Payer: Oxford Commercial	$423.25
Rate for Payer: Qualcare PPO/HMO/WC	$126.97
Rate for Payer: UnitedHealthcare Commercial	$423.25

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$50.83
Max. Negotiated Rate	$195.49
Rate for Payer: Aetna Commercial	$117.29
Rate for Payer: Aetna Medicare Advantage	$117.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.83
Rate for Payer: Oxford Commercial	$195.49
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$195.49

CLIP HEMO LOK MLK LARGE

Facility

$261.28

Hospital Charge Code	270619751
Hospital Revenue Code	272
Min. Negotiated Rate	$33.97
Max. Negotiated Rate	$130.64
Rate for Payer: Aetna Commercial	$78.38
Rate for Payer: Aetna Medicare Advantage	$78.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.97
Rate for Payer: Oxford Commercial	$130.64
Rate for Payer: Qualcare PPO/HMO/WC	$39.19
Rate for Payer: UnitedHealthcare Commercial	$130.64

Know your out-of-pocket cost for care.

All Charges