Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTION ROD LONG

Facility

$51.75

Service Code	HCPCS C1713
Hospital Charge Code	270678087
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$25.88
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: Aetna Medicare Advantage	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.20
Rate for Payer: Cigna Commercial	$25.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

CONNECTIVE TISSUE DISORDERS

Facility

$17,192.46

Service Code	APR-DRG 3463
Min. Negotiated Rate	$13,860.50
Max. Negotiated Rate	$17,192.46
Rate for Payer: Aetna Better Health Medicaid	$16,855.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,192.46
Rate for Payer: Wellpoint Medicaid Managed Care	$13,860.50

CONNECTIVE TISSUE DISORDERS

Facility

$35,564.58

Service Code	APR-DRG 3464
Min. Negotiated Rate	$33,887.16
Max. Negotiated Rate	$35,564.58
Rate for Payer: Aetna Better Health Medicaid	$34,867.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,564.58
Rate for Payer: Wellpoint Medicaid Managed Care	$33,887.16

CONNECTIVE TISSUE DISORDERS

Facility

$8,436.11

Service Code	APR-DRG 3461
Min. Negotiated Rate	$6,193.08
Max. Negotiated Rate	$8,436.11
Rate for Payer: Aetna Better Health Medicaid	$8,270.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,436.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6,193.08

CONNECTIVE TISSUE DISORDERS

Facility

$11,351.59

Service Code	APR-DRG 3462
Min. Negotiated Rate	$8,245.66
Max. Negotiated Rate	$11,351.59
Rate for Payer: Aetna Better Health Medicaid	$11,129.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,351.59
Rate for Payer: Wellpoint Medicaid Managed Care	$8,245.66

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$45,300.51

Service Code	MSDRG 546
Min. Negotiated Rate	$12,586.57
Max. Negotiated Rate	$45,300.51
Rate for Payer: Aetna Commercial	$38,892.50
Rate for Payer: Aetna Medicare Advantage	$12,586.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,080.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,080.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,100.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,080.40
Rate for Payer: Cigna Commercial	$24,822.32
Rate for Payer: Cigna Medicare Advantage	$15,100.17
Rate for Payer: Clover Medicare Advantage	$14,345.16
Rate for Payer: EmblemHealth Commercial	$45,300.51
Rate for Payer: Humana Medicare Advantage	$15,553.18
Rate for Payer: Oxford Commercial	$15,513.23
Rate for Payer: UnitedHealthcare Commercial	$17,608.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,100.17
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,006.18
Rate for Payer: Wellcare Medicare Advantage	$15,100.17

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$83,855.40

Service Code	MSDRG 545
Min. Negotiated Rate	$26,554.21
Max. Negotiated Rate	$83,855.40
Rate for Payer: Aetna Commercial	$83,682.64
Rate for Payer: Aetna Medicare Advantage	$27,081.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68,641.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68,641.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,951.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68,641.83
Rate for Payer: Cigna Commercial	$53,408.67
Rate for Payer: Cigna Medicare Advantage	$27,951.80
Rate for Payer: Clover Medicare Advantage	$26,554.21
Rate for Payer: EmblemHealth Commercial	$83,855.40
Rate for Payer: Humana Medicare Advantage	$28,790.35
Rate for Payer: Oxford Commercial	$33,378.86
Rate for Payer: UnitedHealthcare Commercial	$37,888.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,951.80
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29,628.91
Rate for Payer: Wellcare Medicare Advantage	$27,951.80

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$36,093.54

Service Code	MSDRG 547
Min. Negotiated Rate	$9,125.10
Max. Negotiated Rate	$36,093.54
Rate for Payer: Aetna Commercial	$28,196.56
Rate for Payer: Aetna Medicare Advantage	$9,125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,604.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,604.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,031.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,604.94
Rate for Payer: Cigna Commercial	$17,995.86
Rate for Payer: Cigna Medicare Advantage	$12,031.18
Rate for Payer: Clover Medicare Advantage	$11,429.62
Rate for Payer: EmblemHealth Commercial	$36,093.54
Rate for Payer: Humana Medicare Advantage	$12,392.12
Rate for Payer: Oxford Commercial	$11,246.89
Rate for Payer: UnitedHealthcare Commercial	$12,766.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,031.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,753.05
Rate for Payer: Wellcare Medicare Advantage	$12,031.18

CONNECTOR 25 MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685953
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR 25 MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685953
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,285.50
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.50
Max. Negotiated Rate	$4,005.00
Rate for Payer: Aetna Commercial	$2,403.00
Rate for Payer: Aetna Medicare Advantage	$2,403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,042.55
Rate for Payer: Cigna Commercial	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.50
Max. Negotiated Rate	$1,938.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50

CONNECTOR 3-WAY****

Facility

$9.00

Hospital Charge Code	7000599
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

CONNECTOR 3-WAY****

Facility

$9.00

Hospital Charge Code	7000599
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,285.50
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$1,912.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$1,912.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR ADD-A-VIAL PRIMARY

Facility

$7.70

Hospital Charge Code	6023121
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

Know your out-of-pocket cost for care.

All Charges