Heights University Hospital

All Charges

Charge

Type

Setting

Price

STOPCOCK ROTATION CANNULA 5.8

Facility

$1,575.50

Hospital Charge Code	270689117
Hospital Revenue Code	270
Min. Negotiated Rate	$236.32
Max. Negotiated Rate	$236.32
Rate for Payer: Qualcare PPO/HMO/WC	$236.32

STOPCOCK ROTATION CANNULA 5.8

Facility

$1,575.50

Hospital Charge Code	270689117
Hospital Revenue Code	270
Min. Negotiated Rate	$204.81
Max. Negotiated Rate	$787.75
Rate for Payer: Aetna Commercial	$472.65
Rate for Payer: Aetna Medicare Advantage	$472.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.75
Rate for Payer: Cigna Commercial	$787.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.81
Rate for Payer: Oxford Commercial	$787.75
Rate for Payer: Qualcare PPO/HMO/WC	$236.32
Rate for Payer: UnitedHealthcare Commercial	$787.75

STOP DRILL

Facility

$875.00

Hospital Charge Code	270679988
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

STOP DRILL

Facility

$875.00

Hospital Charge Code	270679988
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.75
Rate for Payer: Oxford Commercial	$437.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$437.50

STOP DRILL 2.3x14MM

Facility

$820.00

Hospital Charge Code	270680170
Hospital Revenue Code	272
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$246.00
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.60
Rate for Payer: Oxford Commercial	$410.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$410.00

STOP DRILL 2.3x14MM

Facility

$820.00

Hospital Charge Code	270680170
Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

STOPPER FOR LISS INSERT GUIDES

Facility

$136.50

Hospital Charge Code	270671203
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$40.95
Rate for Payer: Aetna Medicare Advantage	$40.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.81
Rate for Payer: Cigna Commercial	$68.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.75
Rate for Payer: Oxford Commercial	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.48
Rate for Payer: UnitedHealthcare Commercial	$68.25

STOPPER FOR LISS INSERT GUIDES

Facility

$136.50

Hospital Charge Code	270671203
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$20.48
Rate for Payer: Qualcare PPO/HMO/WC	$20.48

STOXIL 0.5%/4GM

Facility

$89.00

Hospital Charge Code	60633921
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

STOXIL 0.5%/4GM

Facility

$89.00

Hospital Charge Code	60633921
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

STOXIL/15ML

Facility

$95.00

Hospital Charge Code	60634552
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

STOXIL/15ML

Facility

$95.00

Hospital Charge Code	60634552
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

STOXIL OINTMENT/4G

Facility

$84.00

Hospital Charge Code	60634551
Hospital Revenue Code	250
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.92
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$42.00

STOXIL OINTMENT/4G

Facility

$84.00

Hospital Charge Code	60634551
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

STOXIL OPHTH SOLN 1%

Facility

$66.00

Hospital Charge Code	60634531
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

STOXIL OPHTH SOLN 1%

Facility

$66.00

Hospital Charge Code	60634531
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

ST POLY LINER

Facility

$6,362.25

Service Code	HCPCS C1776
Hospital Charge Code	270688879
Hospital Revenue Code	278
Min. Negotiated Rate	$954.34
Max. Negotiated Rate	$1,539.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.66
Rate for Payer: Qualcare PPO/HMO/WC	$954.34

ST POLY LINER

Facility

$6,362.25

Service Code	HCPCS C1776
Hospital Charge Code	270688879
Hospital Revenue Code	278
Min. Negotiated Rate	$954.34
Max. Negotiated Rate	$3,181.12
Rate for Payer: Aetna Commercial	$1,908.67
Rate for Payer: Aetna Medicare Advantage	$1,908.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,622.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,622.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,622.37
Rate for Payer: Cigna Commercial	$3,181.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.66
Rate for Payer: Qualcare PPO/HMO/WC	$954.34

ST PR GPS6FR6x40m6506X40X120

Facility

$1,395.00

Service Code	HCPCS C2617
Hospital Charge Code	270636673N
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$418.50
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

ST PR GPS6FR6x40m6506X40X120

Facility

$1,395.00

Service Code	HCPCS C2617
Hospital Charge Code	270636673N
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

ST PR GPS6FR6x40m6506X40X120

Facility

$1,395.00

Service Code	HCPCS C2617
Hospital Charge Code	270636673S
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$418.50
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

ST PR GPS6FR6x40m6506X40X120

Facility

$6,624.80

Service Code	HCPCS C2617
Hospital Charge Code	270636673
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

ST PR GPS6FR6x40m6506X40X120

Facility

$6,624.80

Service Code	HCPCS C2617
Hospital Charge Code	270636673
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$1,987.44
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

ST PR GPS6FR6x40m6506X40X120

Facility

$1,395.00

Service Code	HCPCS C2617
Hospital Charge Code	270636673S
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

ST PR GPS6FR6x40mSERB650640120

Facility

$7,192.00

Hospital Charge Code	270636673V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.80
Max. Negotiated Rate	$3,596.00
Rate for Payer: Aetna Commercial	$2,157.60
Rate for Payer: Aetna Medicare Advantage	$2,157.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,833.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,833.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,438.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,833.96
Rate for Payer: Cigna Commercial	$3,596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,740.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.80

Know your out-of-pocket cost for care.

All Charges