Heights University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR URETERAL CATHETER

Facility

$7.50

Hospital Charge Code	270655912
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

CONNECTOR URETERAL CATHETER

Facility

$7.50

Hospital Charge Code	270655912
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.75

CONNECTOR Y 6 IN 1 STER 366

Facility

$33.65

Hospital Charge Code	270607253
Hospital Revenue Code	272
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

CONNECTOR Y 6 IN 1 STER 366

Facility

$33.65

Hospital Charge Code	270607253
Hospital Revenue Code	272
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$10.10
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.37
Rate for Payer: Oxford Commercial	$16.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$16.82

CONNECTOR Y RENASYS KIT

Facility

$21.83

Hospital Charge Code	270649380
Hospital Revenue Code	272
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$10.91
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna Medicare Advantage	$6.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.57
Rate for Payer: Cigna Commercial	$10.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.84
Rate for Payer: Oxford Commercial	$10.91
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$10.91

CONNECTOR Y RENASYS KIT

Facility

$21.83

Hospital Charge Code	270649380
Hospital Revenue Code	272
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$1.74
Rate for Payer: Aetna Medicare Advantage	$1.74
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	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.76
Rate for Payer: Oxford Commercial	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$2.90

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$23.12
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$23.12

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

CONNECTOR Y UNIVERSAL WD20

Facility

$72.85

Hospital Charge Code	270605805
Hospital Revenue Code	272
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$21.86
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.47
Rate for Payer: Oxford Commercial	$36.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$36.42

CONNECTOR Y UNIVERSAL WD20

Facility

$72.85

Hospital Charge Code	270605805
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

CONNECTR BMT CLW55-65 11105008

Facility

$2,465.65

Hospital Charge Code	270611653
Hospital Revenue Code	278
Min. Negotiated Rate	$369.85
Max. Negotiated Rate	$596.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$493.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.69
Rate for Payer: Qualcare PPO/HMO/WC	$369.85

CONNECTR BMT CLW55-65 11105008

Facility

$2,465.65

Hospital Charge Code	270611653
Hospital Revenue Code	278
Min. Negotiated Rate	$369.85
Max. Negotiated Rate	$1,232.83
Rate for Payer: Aetna Commercial	$739.70
Rate for Payer: Aetna Medicare Advantage	$739.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$628.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$628.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$493.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$628.74
Rate for Payer: Cigna Commercial	$1,232.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.69
Rate for Payer: Qualcare PPO/HMO/WC	$369.85

CONNEDTOR 5 IN 1 STERILE

Facility

$5.43

Hospital Charge Code	270650406
Hospital Revenue Code	270
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

CONNEDTOR 5 IN 1 STERILE

Facility

$5.43

Hospital Charge Code	270650406
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.71

CONN TISSUE MASSON STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005288
Hospital Revenue Code	310
Min. Negotiated Rate	$46.48
Max. Negotiated Rate	$316.85
Rate for Payer: Aetna Commercial	$201.60
Rate for Payer: Aetna Medicare Advantage	$201.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$46.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

CONN TISSUE MASSON STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005288
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$126.47
Max. Negotiated Rate	$126.47
Rate for Payer: Qualcare PPO/HMO/WC	$126.47

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$109.61
Max. Negotiated Rate	$421.57
Rate for Payer: Aetna Commercial	$252.94
Rate for Payer: Aetna Medicare Advantage	$252.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.00
Rate for Payer: Cigna Commercial	$421.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.61
Rate for Payer: Oxford Commercial	$421.57
Rate for Payer: Qualcare PPO/HMO/WC	$126.47
Rate for Payer: UnitedHealthcare Commercial	$421.57

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$32.50

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.92

Know your out-of-pocket cost for care.

All Charges