Heights University Hospital

All Charges

Charge

Type

Setting

Price

TRAY CATH RAULERSON 11.5FR 6

Facility

$480.00

Service Code	HCPCS C1751
Hospital Charge Code	270615117
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

TRAY CATH TRIPLE LUMEN LG BORE

Facility

$323.82

Service Code	HCPCS C1751
Hospital Charge Code	270650277
Hospital Revenue Code	278
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$161.91
Rate for Payer: Aetna Commercial	$97.15
Rate for Payer: Aetna Medicare Advantage	$97.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.57
Rate for Payer: Cigna Commercial	$161.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.36
Rate for Payer: Qualcare PPO/HMO/WC	$48.57

TRAY CATH TRIPLE LUMEN LG BORE

Facility

$323.82

Service Code	HCPCS C1751
Hospital Charge Code	270650277
Hospital Revenue Code	278
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$78.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.36
Rate for Payer: Qualcare PPO/HMO/WC	$48.57

TRAY CAUTI SILVER 14FR

Facility

$89.48

Hospital Charge Code	270649648
Hospital Revenue Code	270
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$13.42
Rate for Payer: Qualcare PPO/HMO/WC	$13.42

TRAY CAUTI SILVER 14FR

Facility

$89.48

Hospital Charge Code	270649648
Hospital Revenue Code	270
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$44.74
Rate for Payer: Aetna Commercial	$26.84
Rate for Payer: Aetna Medicare Advantage	$26.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.63
Rate for Payer: Oxford Commercial	$44.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.42
Rate for Payer: UnitedHealthcare Commercial	$44.74

TRAY CHEST TUBE

Facility

$327.53

Hospital Charge Code	270693051
Hospital Revenue Code	272
Min. Negotiated Rate	$42.58
Max. Negotiated Rate	$163.76
Rate for Payer: Aetna Commercial	$98.26
Rate for Payer: Aetna Medicare Advantage	$98.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.52
Rate for Payer: Cigna Commercial	$163.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.58
Rate for Payer: Oxford Commercial	$163.76
Rate for Payer: Qualcare PPO/HMO/WC	$49.13
Rate for Payer: UnitedHealthcare Commercial	$163.76

TRAY CHEST TUBE

Facility

$327.53

Hospital Charge Code	270693051
Hospital Revenue Code	272
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$49.13
Rate for Payer: Qualcare PPO/HMO/WC	$49.13

TRAY CHOLANG LAPARO W/TROCAR

Facility

$650.00

Hospital Charge Code	270649267
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

TRAY CHOLANG LAPARO W/TROCAR

Facility

$650.00

Hospital Charge Code	270649267
Hospital Revenue Code	272
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$325.00

TRAY COAXIAL BIOPSY 6CM 11G

Facility

$4,091.65

Service Code	HCPCS C1830
Hospital Charge Code	270688549
Hospital Revenue Code	272
Min. Negotiated Rate	$613.75
Max. Negotiated Rate	$613.75
Rate for Payer: Qualcare PPO/HMO/WC	$613.75

TRAY COAXIAL BIOPSY 6CM 11G

Facility

$4,091.65

Service Code	HCPCS C1830
Hospital Charge Code	270688549
Hospital Revenue Code	272
Min. Negotiated Rate	$531.91
Max. Negotiated Rate	$2,045.83
Rate for Payer: Aetna Commercial	$1,227.49
Rate for Payer: Aetna Medicare Advantage	$1,227.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,043.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,043.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,043.37
Rate for Payer: Cigna Commercial	$2,045.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.91
Rate for Payer: Oxford Commercial	$2,045.83
Rate for Payer: Qualcare PPO/HMO/WC	$613.75
Rate for Payer: UnitedHealthcare Commercial	$2,045.83

TRAY CRANIOTOMY

Facility

$565.60

Hospital Charge Code	270667449
Hospital Revenue Code	270
Min. Negotiated Rate	$73.53
Max. Negotiated Rate	$282.80
Rate for Payer: Aetna Commercial	$169.68
Rate for Payer: Aetna Medicare Advantage	$169.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.23
Rate for Payer: Cigna Commercial	$282.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.53
Rate for Payer: Oxford Commercial	$282.80
Rate for Payer: Qualcare PPO/HMO/WC	$84.84
Rate for Payer: UnitedHealthcare Commercial	$282.80

TRAY CRANIOTOMY

Facility

$565.60

Hospital Charge Code	270667449
Hospital Revenue Code	270
Min. Negotiated Rate	$84.84
Max. Negotiated Rate	$84.84
Rate for Payer: Qualcare PPO/HMO/WC	$84.84

TRAY C-SECTION DELIVERY PK

Facility

$569.53

Hospital Charge Code	270650963
Hospital Revenue Code	272
Min. Negotiated Rate	$74.04
Max. Negotiated Rate	$284.76
Rate for Payer: Aetna Commercial	$170.86
Rate for Payer: Aetna Medicare Advantage	$170.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.23
Rate for Payer: Cigna Commercial	$284.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.04
Rate for Payer: Oxford Commercial	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$85.43
Rate for Payer: UnitedHealthcare Commercial	$284.76

TRAY C-SECTION DELIVERY PK

Facility

$569.53

Hospital Charge Code	270650963
Hospital Revenue Code	272
Min. Negotiated Rate	$85.43
Max. Negotiated Rate	$85.43
Rate for Payer: Qualcare PPO/HMO/WC	$85.43

TRAY C-SECTION PACK

Facility

$523.25

Hospital Charge Code	270600577
Hospital Revenue Code	272
Min. Negotiated Rate	$68.02
Max. Negotiated Rate	$261.62
Rate for Payer: Aetna Commercial	$156.97
Rate for Payer: Aetna Medicare Advantage	$156.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.43
Rate for Payer: Cigna Commercial	$261.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.02
Rate for Payer: Oxford Commercial	$261.62
Rate for Payer: Qualcare PPO/HMO/WC	$78.49
Rate for Payer: UnitedHealthcare Commercial	$261.62

TRAY C-SECTION PACK

Facility

$523.25

Hospital Charge Code	270600577
Hospital Revenue Code	272
Min. Negotiated Rate	$78.49
Max. Negotiated Rate	$78.49
Rate for Payer: Qualcare PPO/HMO/WC	$78.49

TRAY CUSTOM EYE DR G AS5276-05

Facility

$1,702.45

Hospital Charge Code	270606277
Hospital Revenue Code	276
Min. Negotiated Rate	$255.37
Max. Negotiated Rate	$411.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.99
Rate for Payer: Qualcare PPO/HMO/WC	$255.37

TRAY CUSTOM EYE DR G AS5276-05

Facility

$1,702.45

Hospital Charge Code	270606277
Hospital Revenue Code	276
Min. Negotiated Rate	$255.37
Max. Negotiated Rate	$851.23
Rate for Payer: Aetna Commercial	$510.74
Rate for Payer: Aetna Medicare Advantage	$510.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.12
Rate for Payer: Cigna Commercial	$851.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.99
Rate for Payer: Qualcare PPO/HMO/WC	$255.37

TRAY CYSTO

Facility

$90.35

Hospital Charge Code	270654145
Hospital Revenue Code	270
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$45.17
Rate for Payer: Aetna Commercial	$27.11
Rate for Payer: Aetna Medicare Advantage	$27.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.04
Rate for Payer: Cigna Commercial	$45.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.75
Rate for Payer: Oxford Commercial	$45.17
Rate for Payer: Qualcare PPO/HMO/WC	$13.55
Rate for Payer: UnitedHealthcare Commercial	$45.17

TRAY CYSTO

Facility

$90.35

Hospital Charge Code	270654145
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$13.55

TRAY DIALYSIS 3 LUMEN CV

Facility

$367.32

Hospital Charge Code	270649140
Hospital Revenue Code	272
Min. Negotiated Rate	$47.75
Max. Negotiated Rate	$183.66
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$110.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.67
Rate for Payer: Cigna Commercial	$183.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.75
Rate for Payer: Oxford Commercial	$183.66
Rate for Payer: Qualcare PPO/HMO/WC	$55.10
Rate for Payer: UnitedHealthcare Commercial	$183.66

TRAY DIALYSIS 3 LUMEN CV

Facility

$367.32

Hospital Charge Code	270649140
Hospital Revenue Code	272
Min. Negotiated Rate	$55.10
Max. Negotiated Rate	$55.10
Rate for Payer: Qualcare PPO/HMO/WC	$55.10

TRAY DOBHOFF FEEDING

Facility

$156.85

Hospital Charge Code	8000788
Hospital Revenue Code	270
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$78.42
Rate for Payer: Aetna Commercial	$47.05
Rate for Payer: Aetna Medicare Advantage	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.00
Rate for Payer: Cigna Commercial	$78.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.39
Rate for Payer: Oxford Commercial	$78.42
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$78.42

TRAY DOBHOFF FEEDING

Facility

$156.85

Hospital Charge Code	8000788
Hospital Revenue Code	270
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

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