Heights University Hospital

All Charges

Charge

Type

Setting

Price

CAP ASF PSN 12 MM VEL 3

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690103
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

CAP ASF PSN 12 MM VEL 3

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690103
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,200.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

CAP BICART RENAL

Facility

$9.65

Hospital Charge Code	270606422
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

CAP BICART RENAL

Facility

$9.65

Hospital Charge Code	270606422
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

CAP BLUE SEALING 6-12F

Facility

$33.00

Hospital Charge Code	270617618
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

CAP BLUE SEALING 6-12F

Facility

$33.00

Hospital Charge Code	270617618
Hospital Revenue Code	270
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

CAP BOUFFANT BLUE 24

Facility

$0.21

Hospital Charge Code	270648966
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.03

CAP BOUFFANT BLUE 24

Facility

$0.21

Hospital Charge Code	270648966
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna Commercial	$0.06
Rate for Payer: Aetna Medicare Advantage	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.05
Rate for Payer: Cigna Commercial	$0.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.03
Rate for Payer: Oxford Commercial	$0.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.03
Rate for Payer: UnitedHealthcare Commercial	$0.11

CAP BOUFFANT BLUE 27

Facility

$30.47

Hospital Charge Code	270060200C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$15.23
Rate for Payer: Aetna Commercial	$9.14
Rate for Payer: Aetna Medicare Advantage	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.77
Rate for Payer: Cigna Commercial	$15.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$15.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$15.23

CAP BOUFFANT BLUE 27

Facility

$30.47

Hospital Charge Code	270060200C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.57

CAP BOUFFANT GREEN 24

Facility

$0.24

Hospital Charge Code	270648965
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.04

CAP BOUFFANT GREEN 24

Facility

$0.24

Hospital Charge Code	270648965
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna Commercial	$0.07
Rate for Payer: Aetna Medicare Advantage	$0.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.06
Rate for Payer: Cigna Commercial	$0.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.03
Rate for Payer: Oxford Commercial	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.04
Rate for Payer: UnitedHealthcare Commercial	$0.12

CAP BOUFFANT HW 24IN BLUE

Facility

$209.60

Hospital Charge Code	270664786
Hospital Revenue Code	270
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$104.80
Rate for Payer: Aetna Commercial	$62.88
Rate for Payer: Aetna Medicare Advantage	$62.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.45
Rate for Payer: Cigna Commercial	$104.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.25
Rate for Payer: Oxford Commercial	$104.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.44
Rate for Payer: UnitedHealthcare Commercial	$104.80

CAP BOUFFANT HW 24IN BLUE

Facility

$209.60

Hospital Charge Code	270664786
Hospital Revenue Code	270
Min. Negotiated Rate	$31.44
Max. Negotiated Rate	$31.44
Rate for Payer: Qualcare PPO/HMO/WC	$31.44

CAP BOUFFANT WHITE 24

Facility

$0.60

Hospital Charge Code	270648967
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.09

CAP BOUFFANT WHITE 24

Facility

$0.60

Hospital Charge Code	270648967
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna Commercial	$0.18
Rate for Payer: Aetna Medicare Advantage	$0.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.15
Rate for Payer: Cigna Commercial	$0.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.08
Rate for Payer: Oxford Commercial	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.09
Rate for Payer: UnitedHealthcare Commercial	$0.30

CAP CPS ASF PSN 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689795
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CAP CPS ASF PSN 14MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689795
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CAP DPY PIN 5MM FF10551

Facility

$65.65

Hospital Charge Code	270612490
Hospital Revenue Code	272
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Aetna Commercial	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.53
Rate for Payer: Oxford Commercial	$32.83
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$32.83

CAP DPY PIN 5MM FF10551

Facility

$65.65

Hospital Charge Code	270612490
Hospital Revenue Code	272
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

CAP EDS SCREW 7000-0000

Facility

$730.45

Hospital Charge Code	270628751
Hospital Revenue Code	272
Min. Negotiated Rate	$94.96
Max. Negotiated Rate	$365.23
Rate for Payer: Aetna Commercial	$219.13
Rate for Payer: Aetna Medicare Advantage	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.26
Rate for Payer: Cigna Commercial	$365.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.96
Rate for Payer: Oxford Commercial	$365.23
Rate for Payer: Qualcare PPO/HMO/WC	$109.57
Rate for Payer: UnitedHealthcare Commercial	$365.23

CAP EDS SCREW 7000-0000

Facility

$730.45

Hospital Charge Code	270628751
Hospital Revenue Code	272
Min. Negotiated Rate	$109.57
Max. Negotiated Rate	$109.57
Rate for Payer: Qualcare PPO/HMO/WC	$109.57

CAP END 10mm

Facility

$805.00

Hospital Charge Code	270665225
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$194.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.81
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

CAP END 10mm

Facility

$805.00

Hospital Charge Code	270665225
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$402.50
Rate for Payer: Aetna Commercial	$241.50
Rate for Payer: Aetna Medicare Advantage	$241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.28
Rate for Payer: Cigna Commercial	$402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.81
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

CAP END 10mm DC29259

Facility

$744.00

Hospital Charge Code	270635454
Hospital Revenue Code	272
Min. Negotiated Rate	$96.72
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Commercial	$372.00

Know your out-of-pocket cost for care.

All Charges