Heights University Hospital

All Charges

Charge

Type

Setting

Price

HOFFMAN STATIC STRUTMEDLRF40MM

Facility

$474.70

Service Code	HCPCS C1713
Hospital Charge Code	270700227
Hospital Revenue Code	278
Min. Negotiated Rate	$71.20
Max. Negotiated Rate	$237.35
Rate for Payer: Aetna Commercial	$142.41
Rate for Payer: Aetna Medicare Advantage	$142.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.05
Rate for Payer: Cigna Commercial	$237.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.88
Rate for Payer: Qualcare PPO/HMO/WC	$71.20

HOFFMANTELESTRUTXSLRF100-125MM

Facility

$16,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270700226
Hospital Revenue Code	278
Min. Negotiated Rate	$2,446.50
Max. Negotiated Rate	$8,155.00
Rate for Payer: Aetna Commercial	$4,893.00
Rate for Payer: Aetna Medicare Advantage	$4,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,159.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,159.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,159.05
Rate for Payer: Cigna Commercial	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,947.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,446.50

HOFFMANTELESTRUTXSLRF100-125MM

Facility

$16,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270700226
Hospital Revenue Code	278
Min. Negotiated Rate	$2,446.50
Max. Negotiated Rate	$3,947.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,947.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,446.50

HOFFMAN WASHER LRF 2MM YELLOW

Facility

$287.85

Service Code	HCPCS C1713
Hospital Charge Code	270700228
Hospital Revenue Code	278
Min. Negotiated Rate	$43.18
Max. Negotiated Rate	$143.93
Rate for Payer: Aetna Commercial	$86.36
Rate for Payer: Aetna Medicare Advantage	$86.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.40
Rate for Payer: Cigna Commercial	$143.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.66
Rate for Payer: Qualcare PPO/HMO/WC	$43.18

HOFFMAN WASHER LRF 2MM YELLOW

Facility

$287.85

Service Code	HCPCS C1713
Hospital Charge Code	270700228
Hospital Revenue Code	278
Min. Negotiated Rate	$43.18
Max. Negotiated Rate	$69.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.66
Rate for Payer: Qualcare PPO/HMO/WC	$43.18

HOHMANN-STYLE RETRACTOR

Facility

$1,158.00

Hospital Charge Code	270659360
Hospital Revenue Code	272
Min. Negotiated Rate	$150.54
Max. Negotiated Rate	$579.00
Rate for Payer: Aetna Commercial	$347.40
Rate for Payer: Aetna Medicare Advantage	$347.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.29
Rate for Payer: Cigna Commercial	$579.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.54
Rate for Payer: Oxford Commercial	$579.00
Rate for Payer: Qualcare PPO/HMO/WC	$173.70
Rate for Payer: UnitedHealthcare Commercial	$579.00

HOHMANN-STYLE RETRACTOR

Facility

$1,158.00

Hospital Charge Code	270659360
Hospital Revenue Code	272
Min. Negotiated Rate	$173.70
Max. Negotiated Rate	$173.70
Rate for Payer: Qualcare PPO/HMO/WC	$173.70

HOLDER BACKSTOP MINI SHARP

Facility

$30.75

Hospital Charge Code	270662069
Hospital Revenue Code	272
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: Qualcare PPO/HMO/WC	$4.61

HOLDER BACKSTOP MINI SHARP

Facility

$30.75

Hospital Charge Code	270662069
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$15.38
Rate for Payer: Aetna Commercial	$9.22
Rate for Payer: Aetna Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.84
Rate for Payer: Cigna Commercial	$15.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.00
Rate for Payer: Oxford Commercial	$15.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.61
Rate for Payer: UnitedHealthcare Commercial	$15.38

HOLDER BAG BLOOD

Facility

$40.00

Hospital Charge Code	270665717
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

HOLDER BAG BLOOD

Facility

$40.00

Hospital Charge Code	270665717
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

HOLDER DPY 1 PIN FA10355

Facility

$1,444.00

Hospital Charge Code	270612443
Hospital Revenue Code	272
Min. Negotiated Rate	$216.60
Max. Negotiated Rate	$216.60
Rate for Payer: Qualcare PPO/HMO/WC	$216.60

HOLDER DPY 1 PIN FA10355

Facility

$1,444.00

Hospital Charge Code	270612443
Hospital Revenue Code	272
Min. Negotiated Rate	$187.72
Max. Negotiated Rate	$722.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$433.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.22
Rate for Payer: Cigna Commercial	$722.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.72
Rate for Payer: Oxford Commercial	$722.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.60
Rate for Payer: UnitedHealthcare Commercial	$722.00

HOLDER DPY 2 PIN FA10360

Facility

$2,323.25

Hospital Charge Code	270612487
Hospital Revenue Code	272
Min. Negotiated Rate	$302.02
Max. Negotiated Rate	$1,161.62
Rate for Payer: Aetna Commercial	$696.98
Rate for Payer: Aetna Medicare Advantage	$696.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.43
Rate for Payer: Cigna Commercial	$1,161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.02
Rate for Payer: Oxford Commercial	$1,161.62
Rate for Payer: Qualcare PPO/HMO/WC	$348.49
Rate for Payer: UnitedHealthcare Commercial	$1,161.62

HOLDER DPY 2 PIN FA10360

Facility

$2,323.25

Hospital Charge Code	270612487
Hospital Revenue Code	272
Min. Negotiated Rate	$348.49
Max. Negotiated Rate	$348.49
Rate for Payer: Qualcare PPO/HMO/WC	$348.49

HOLDER DPY 3 PIN FA10365

Facility

$2,348.85

Hospital Charge Code	270612444
Hospital Revenue Code	272
Min. Negotiated Rate	$352.33
Max. Negotiated Rate	$352.33
Rate for Payer: Qualcare PPO/HMO/WC	$352.33

HOLDER DPY 3 PIN FA10365

Facility

$2,348.85

Hospital Charge Code	270612444
Hospital Revenue Code	272
Min. Negotiated Rate	$305.35
Max. Negotiated Rate	$1,174.42
Rate for Payer: Aetna Commercial	$704.65
Rate for Payer: Aetna Medicare Advantage	$704.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$598.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$598.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$598.96
Rate for Payer: Cigna Commercial	$1,174.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.35
Rate for Payer: Oxford Commercial	$1,174.42
Rate for Payer: Qualcare PPO/HMO/WC	$352.33
Rate for Payer: UnitedHealthcare Commercial	$1,174.42

HOLDER ENDOTRACH*****

Facility

$43.00

Hospital Charge Code	8000622
Hospital Revenue Code	279
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

HOLDER ENDOTRACH*****

Facility

$43.00

Hospital Charge Code	8000622
Hospital Revenue Code	279
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

HOLDER ET TUBE ADHESIVE

Facility

$38.70

Hospital Charge Code	270302217
Hospital Revenue Code	270
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.80

HOLDER ET TUBE ADHESIVE

Facility

$38.70

Hospital Charge Code	270302217
Hospital Revenue Code	270
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$19.35
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.87
Rate for Payer: Cigna Commercial	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$5.80
Rate for Payer: UnitedHealthcare Commercial	$19.35

HOLDER INSTRUMENT LAPKIT LK700

Facility

$12.35

Hospital Charge Code	270635070
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.85

HOLDER INSTRUMENT LAPKIT LK700

Facility

$12.35

Hospital Charge Code	270635070
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$6.17
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare Advantage	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.15
Rate for Payer: Cigna Commercial	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$6.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.85
Rate for Payer: UnitedHealthcare Commercial	$6.17

HOLDER LIMB DISP*****

Facility

$7.00

Hospital Charge Code	8003378
Hospital Revenue Code	279
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

HOLDER LIMB DISP*****

Facility

$7.00

Hospital Charge Code	8003378
Hospital Revenue Code	279
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

Know your out-of-pocket cost for care.

All Charges