Heights University Hospital

All Charges

Charge

Type

Setting

Price

KIT STAPLE STRAIGHT 8X 8 MM

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270700260
Hospital Revenue Code	278
Min. Negotiated Rate	$987.75
Max. Negotiated Rate	$1,593.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: Qualcare PPO/HMO/WC	$987.75

KIT STAPLE STRAIGHT 8X 8 MM

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270700260
Hospital Revenue Code	278
Min. Negotiated Rate	$987.75
Max. Negotiated Rate	$3,292.50
Rate for Payer: Aetna Commercial	$1,975.50
Rate for Payer: Aetna Medicare Advantage	$1,975.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,679.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,679.17
Rate for Payer: Cigna Commercial	$3,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,593.57
Rate for Payer: Qualcare PPO/HMO/WC	$987.75

KIT STERILE WATER 1000ml

Facility

$14.58

Hospital Charge Code	270645085
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$7.29
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna Medicare Advantage	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.72
Rate for Payer: Cigna Commercial	$7.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.90
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$7.29

KIT STERILE WATER 1000ml

Facility

$14.58

Hospital Charge Code	270645085
Hospital Revenue Code	270
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

KIT STYLET

Facility

$564.85

Hospital Charge Code	270606342
Hospital Revenue Code	272
Min. Negotiated Rate	$84.73
Max. Negotiated Rate	$84.73
Rate for Payer: Qualcare PPO/HMO/WC	$84.73

KIT STYLET

Facility

$564.85

Hospital Charge Code	270606342
Hospital Revenue Code	272
Min. Negotiated Rate	$73.43
Max. Negotiated Rate	$282.43
Rate for Payer: Aetna Commercial	$169.46
Rate for Payer: Aetna Medicare Advantage	$169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.04
Rate for Payer: Cigna Commercial	$282.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.43
Rate for Payer: Oxford Commercial	$282.43
Rate for Payer: Qualcare PPO/HMO/WC	$84.73
Rate for Payer: UnitedHealthcare Commercial	$282.43

KIT STYLET 6057-58

Facility

$198.45

Hospital Charge Code	270615018
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

KIT STYLET 6057-58

Facility

$198.45

Hospital Charge Code	270615018
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$59.53
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.80
Rate for Payer: Oxford Commercial	$99.22
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$99.22

KIT SUCTION W/CUP 14FR

Facility

$2.06

Hospital Charge Code	270649681
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.31

KIT SUCTION W/CUP 14FR

Facility

$2.06

Hospital Charge Code	270649681
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna Commercial	$0.62
Rate for Payer: Aetna Medicare Advantage	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.53
Rate for Payer: Cigna Commercial	$1.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.27
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.31
Rate for Payer: UnitedHealthcare Commercial	$1.03

KIT SUPERION IDS 102-9800

Facility

$1,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270698877
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

KIT SUPERION IDS 102-9800

Facility

$1,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270698877
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

KIT SURFIT LOOP OSTOMY ******

Facility

$32.00

Hospital Charge Code	8002669
Hospital Revenue Code	279
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

KIT SURFIT LOOP OSTOMY ******

Facility

$32.00

Hospital Charge Code	8002669
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104S
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$13.72
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Oxford Commercial	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$22.88

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104S
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$13.72
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Oxford Commercial	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$22.88

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

KIT SUTURE

Facility

$45.75

Hospital Charge Code	270681104N
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$13.72
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Oxford Commercial	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$22.88

KIT SUTURTAK CURVED

Facility

$975.00

Hospital Charge Code	270677688
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

KIT SUTURTAK CURVED

Facility

$975.00

Hospital Charge Code	270677688
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$487.50

KIT SWNSN 2ND METATRSL 426BSML

Facility

$8,000.00

Hospital Charge Code	270619432
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

KIT SWNSN 2ND METATRSL 426BSML

Facility

$8,000.00

Hospital Charge Code	270619432
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$2,400.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

KIT SWNSN TITANUM TOE 2483KITA

Facility

$6,919.25

Hospital Charge Code	270611922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,037.89
Max. Negotiated Rate	$1,674.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,383.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,674.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,037.89

Know your out-of-pocket cost for care.

All Charges