Heights University Hospital

All Charges

Charge

Type

Setting

Price

STAPLES SINGLE N

Facility

$1,647.85

Hospital Charge Code	270670928
Hospital Revenue Code	272
Min. Negotiated Rate	$247.18
Max. Negotiated Rate	$247.18
Rate for Payer: Qualcare PPO/HMO/WC	$247.18

STAPLE STR NITINOL 8X8MM

Facility

$6,036.25

Service Code	HCPCS C1713
Hospital Charge Code	270700181
Hospital Revenue Code	278
Min. Negotiated Rate	$905.44
Max. Negotiated Rate	$1,460.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,460.77
Rate for Payer: Qualcare PPO/HMO/WC	$905.44

STAPLE STR NITINOL 8X8MM

Facility

$6,036.25

Service Code	HCPCS C1713
Hospital Charge Code	270700181
Hospital Revenue Code	278
Min. Negotiated Rate	$905.44
Max. Negotiated Rate	$3,018.12
Rate for Payer: Aetna Commercial	$1,810.88
Rate for Payer: Aetna Medicare Advantage	$1,810.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,539.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,539.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,539.24
Rate for Payer: Cigna Commercial	$3,018.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,460.77
Rate for Payer: Qualcare PPO/HMO/WC	$905.44

STAPLE SUPER MX NITI 20WX15L

Facility

$17,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270693215
Hospital Revenue Code	278
Min. Negotiated Rate	$2,673.75
Max. Negotiated Rate	$8,912.50
Rate for Payer: Aetna Commercial	$5,347.50
Rate for Payer: Aetna Medicare Advantage	$5,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,545.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,545.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,545.38
Rate for Payer: Cigna Commercial	$8,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,313.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,673.75

STAPLE SUPER MX NITI 20WX15L

Facility

$17,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270693215
Hospital Revenue Code	278
Min. Negotiated Rate	$2,673.75
Max. Negotiated Rate	$4,313.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,313.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,673.75

STAPLE SYSTEM 10X10X10MM

Facility

$6,270.00

Service Code	HCPCS C1713
Hospital Charge Code	270690538
Hospital Revenue Code	278
Min. Negotiated Rate	$940.50
Max. Negotiated Rate	$1,517.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: Qualcare PPO/HMO/WC	$940.50

STAPLE SYSTEM 10X10X10MM

Facility

$6,270.00

Service Code	HCPCS C1713
Hospital Charge Code	270690538
Hospital Revenue Code	278
Min. Negotiated Rate	$940.50
Max. Negotiated Rate	$3,135.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,881.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,598.85
Rate for Payer: Cigna Commercial	$3,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: Qualcare PPO/HMO/WC	$940.50

STAPLE UNI-CLIP NTCH 15x12MM L

Facility

$3,868.55

Hospital Charge Code	270668132
Hospital Revenue Code	272
Min. Negotiated Rate	$502.91
Max. Negotiated Rate	$1,934.28
Rate for Payer: Aetna Commercial	$1,160.57
Rate for Payer: Aetna Medicare Advantage	$1,160.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$986.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$986.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$986.48
Rate for Payer: Cigna Commercial	$1,934.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$502.91
Rate for Payer: Oxford Commercial	$1,934.28
Rate for Payer: Qualcare PPO/HMO/WC	$580.28
Rate for Payer: UnitedHealthcare Commercial	$1,934.28

STAPLE UNI-CLIP NTCH 15x12MM L

Facility

$3,868.55

Hospital Charge Code	270668132
Hospital Revenue Code	272
Min. Negotiated Rate	$580.28
Max. Negotiated Rate	$580.28
Rate for Payer: Qualcare PPO/HMO/WC	$580.28

STAPLE Z 10/11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695607
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$1,650.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STAPLE Z 10/11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695607
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$68.99
Max. Negotiated Rate	$68.99
Rate for Payer: Qualcare PPO/HMO/WC	$68.99

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$59.79
Max. Negotiated Rate	$229.96
Rate for Payer: Aetna Commercial	$137.98
Rate for Payer: Aetna Medicare Advantage	$137.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.28
Rate for Payer: Cigna Commercial	$229.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.79
Rate for Payer: Oxford Commercial	$229.96
Rate for Payer: Qualcare PPO/HMO/WC	$68.99
Rate for Payer: UnitedHealthcare Commercial	$229.96

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$6.53
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.83
Rate for Payer: Oxford Commercial	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$10.89

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

STARLIX 60MG TAB

Facility

$2.00

Hospital Charge Code	60635429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

STARLIX 60MG TAB

Facility

$2.00

Hospital Charge Code	60635429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$250.00

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$688.42
Max. Negotiated Rate	$688.42
Rate for Payer: Qualcare PPO/HMO/WC	$688.42

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$596.63
Max. Negotiated Rate	$2,294.75
Rate for Payer: Aetna Commercial	$1,376.85
Rate for Payer: Aetna Medicare Advantage	$1,376.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.32
Rate for Payer: Cigna Commercial	$2,294.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$596.63
Rate for Payer: Oxford Commercial	$2,294.75
Rate for Payer: Qualcare PPO/HMO/WC	$688.42
Rate for Payer: UnitedHealthcare Commercial	$2,294.75

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$141.82
Max. Negotiated Rate	$141.82
Rate for Payer: Qualcare PPO/HMO/WC	$141.82

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$472.72
Rate for Payer: Aetna Commercial	$283.63
Rate for Payer: Aetna Medicare Advantage	$283.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.09
Rate for Payer: Cigna Commercial	$472.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.91
Rate for Payer: Oxford Commercial	$472.72
Rate for Payer: Qualcare PPO/HMO/WC	$141.82
Rate for Payer: UnitedHealthcare Commercial	$472.72

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$122.90
Max. Negotiated Rate	$472.70
Rate for Payer: Aetna Commercial	$283.62
Rate for Payer: Aetna Medicare Advantage	$283.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.08
Rate for Payer: Cigna Commercial	$472.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.90
Rate for Payer: Oxford Commercial	$472.70
Rate for Payer: Qualcare PPO/HMO/WC	$141.81
Rate for Payer: UnitedHealthcare Commercial	$472.70

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$141.81
Max. Negotiated Rate	$141.81
Rate for Payer: Qualcare PPO/HMO/WC	$141.81

Know your out-of-pocket cost for care.

All Charges