Heights University Hospital

All Charges

Charge

Type

Setting

Price

CLOS SYS PORT ENDO CART THOM I

Facility

$976.50

Hospital Charge Code	270675138
Hospital Revenue Code	272
Min. Negotiated Rate	$146.47
Max. Negotiated Rate	$146.47
Rate for Payer: Qualcare PPO/HMO/WC	$146.47

CLOS SYS PORT ENDO CART THOM I

Facility

$976.50

Hospital Charge Code	270675138
Hospital Revenue Code	272
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$488.25
Rate for Payer: Aetna Commercial	$292.95
Rate for Payer: Aetna Medicare Advantage	$292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.01
Rate for Payer: Cigna Commercial	$488.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.94
Rate for Payer: Oxford Commercial	$488.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.47
Rate for Payer: UnitedHealthcare Commercial	$488.25

CLOSTRIDIUM DIFFERICILE TOXIN

Facility

$292.37

Service Code	HCPCS 87449
Hospital Charge Code	399900537
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.86
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

CLOSTRIDIUM DIFFERICILE TOXIN

Facility

$292.37

Service Code	HCPCS 87449
Hospital Charge Code	399900537
Hospital Revenue Code	302
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$43.86
Rate for Payer: Qualcare PPO/HMO/WC	$43.86

CLOSTRIDIUM DIFFICILE TOXIN A

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3004819
Hospital Revenue Code	309
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.96
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.33
Rate for Payer: Cigna Commercial	$19.74
Rate for Payer: Cigna Medicare Advantage	$9.87
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.92
Rate for Payer: Wellcare Medicare Advantage	$19.74

CLOSTRIDIUM DIFFICILE TOXIN A

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3004819
Hospital Revenue Code	309
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$24.73
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$63.96
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.33
Rate for Payer: Cigna Commercial	$19.74
Rate for Payer: Cigna Medicare Advantage	$9.87
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$20.92
Rate for Payer: Wellcare Medicare Advantage	$19.74

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$136.56
Rate for Payer: Aetna Commercial	$120.75
Rate for Payer: Aetna Medicare Advantage	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.56
Rate for Payer: Cigna Commercial	$37.27
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$35.41
Rate for Payer: EmblemHealth Commercial	$111.81
Rate for Payer: Humana Medicare Advantage	$38.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$39.51
Rate for Payer: Wellcare Medicare Advantage	$37.27

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$307.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Hospital Charge Code	270642941
Hospital Revenue Code	279
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$525.00

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$315.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Hospital Charge Code	270642941
Hospital Revenue Code	279
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$307.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$741.40
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,710.91
Rate for Payer: Aetna Medicare Advantage	$1,710.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.28
Rate for Payer: Cigna Commercial	$2,373.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.46
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$855.46
Max. Negotiated Rate	$855.46
Rate for Payer: Qualcare PPO/HMO/WC	$855.46

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$76.25
Rate for Payer: Aetna Commercial	$45.75
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.89
Rate for Payer: Cigna Commercial	$76.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$76.25
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$76.25

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$67.12
Max. Negotiated Rate	$67.12
Rate for Payer: Qualcare PPO/HMO/WC	$67.12

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$58.17
Max. Negotiated Rate	$223.75
Rate for Payer: Aetna Commercial	$134.25
Rate for Payer: Aetna Medicare Advantage	$134.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.11
Rate for Payer: Cigna Commercial	$223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.17
Rate for Payer: Oxford Commercial	$223.75
Rate for Payer: Qualcare PPO/HMO/WC	$67.12
Rate for Payer: UnitedHealthcare Commercial	$223.75

CLOSURE NEEDLE-EXCEL DPC610***

Facility

$125.00

Hospital Charge Code	1606094
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

Know your out-of-pocket cost for care.

All Charges