Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCRUB TOP 2PK MISTY ENCORE

Facility

$24.85

Hospital Charge Code	270658931
Hospital Revenue Code	270
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$7.46
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.23
Rate for Payer: Oxford Commercial	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$12.43

SCRUB TOP 2PKT MISTY ENCORE

Facility

$26.25

Hospital Charge Code	270658926
Hospital Revenue Code	270
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$13.12
Rate for Payer: Aetna Commercial	$7.88
Rate for Payer: Aetna Medicare Advantage	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.69
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.41
Rate for Payer: Oxford Commercial	$13.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.94
Rate for Payer: UnitedHealthcare Commercial	$13.12

SCRUB TOP 2PKT MISTY ENCORE

Facility

$26.25

Hospital Charge Code	270658926
Hospital Revenue Code	270
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$3.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.94

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.00

Hospital Charge Code	270658923
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.00

Hospital Charge Code	270658923
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SCRUB TOP 2PKT MISTY ENCORE

Facility

$22.80

Hospital Charge Code	270658927
Hospital Revenue Code	270
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$11.40
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$6.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.81
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.96
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Commercial	$11.40

SCRUB TOP 2PKT MISTY ENCORE

Facility

$22.80

Hospital Charge Code	270658927
Hospital Revenue Code	270
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$3.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.42

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.65

Hospital Charge Code	270658925
Hospital Revenue Code	270
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.95

SCRUB TOP 2PKT MISTY ENCORE

Facility

$19.65

Hospital Charge Code	270658925
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$9.82
Rate for Payer: Aetna Commercial	$5.89
Rate for Payer: Aetna Medicare Advantage	$5.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.01
Rate for Payer: Cigna Commercial	$9.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.55
Rate for Payer: Oxford Commercial	$9.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.95
Rate for Payer: UnitedHealthcare Commercial	$9.82

SCRW 2.0m x6m CORT SELF401.936

Facility

$210.85

Hospital Charge Code	270635601
Hospital Revenue Code	278
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$51.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.63

SCRW 2.0m x6m CORT SELF401.936

Facility

$210.85

Hospital Charge Code	270635601
Hospital Revenue Code	278
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$105.42
Rate for Payer: Aetna Commercial	$63.26
Rate for Payer: Aetna Medicare Advantage	$63.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.77
Rate for Payer: Cigna Commercial	$105.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.63

SCRW 2.0X36 LAG CANNULATED

Facility

$1,575.00

Hospital Charge Code	270648908
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$472.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

SCRW 2.0X36 LAG CANNULATED

Facility

$1,575.00

Hospital Charge Code	270648908
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$191.88
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$191.88
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x16MM LOCK 53-27616E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x16MM LOCK 53-27616E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x18MM LOCK 53-27618E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x18MM LOCK 53-27618E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x20MM LOCK 53-27620E

Facility

$780.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$234.00
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x20MM LOCK 53-27620E

Facility

$780.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

Know your out-of-pocket cost for care.

All Charges