Heights University Hospital

All Charges

Charge

Type

Setting

Price

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$314.38
Max. Negotiated Rate	$314.38
Rate for Payer: Qualcare PPO/HMO/WC	$314.38

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$272.46
Max. Negotiated Rate	$1,047.92
Rate for Payer: Aetna Commercial	$628.75
Rate for Payer: Aetna Medicare Advantage	$628.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.44
Rate for Payer: Cigna Commercial	$1,047.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.46
Rate for Payer: Oxford Commercial	$1,047.92
Rate for Payer: Qualcare PPO/HMO/WC	$314.38
Rate for Payer: UnitedHealthcare Commercial	$1,047.92

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$257.99
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.80
Rate for Payer: Oxford Commercial	$429.99
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Commercial	$429.99

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G .035/260cm ANGL

Facility

$987.50

Hospital Charge Code	270644053
Hospital Revenue Code	272
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$148.12
Rate for Payer: Qualcare PPO/HMO/WC	$148.12

DREAMWIRE F/G .035/260cm ANGL

Facility

$987.50

Hospital Charge Code	270644053
Hospital Revenue Code	272
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$493.75
Rate for Payer: Aetna Commercial	$296.25
Rate for Payer: Aetna Medicare Advantage	$296.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.81
Rate for Payer: Cigna Commercial	$493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.38
Rate for Payer: Oxford Commercial	$493.75
Rate for Payer: Qualcare PPO/HMO/WC	$148.12
Rate for Payer: UnitedHealthcare Commercial	$493.75

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$128.67
Max. Negotiated Rate	$207.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: Qualcare PPO/HMO/WC	$128.67

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$128.67
Max. Negotiated Rate	$428.92
Rate for Payer: Aetna Commercial	$257.35
Rate for Payer: Aetna Medicare Advantage	$257.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.75
Rate for Payer: Cigna Commercial	$428.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: Qualcare PPO/HMO/WC	$128.67

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$257.99
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G .035/STIFF/450

Facility

$987.50

Hospital Charge Code	270648013
Hospital Revenue Code	272
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$148.12
Rate for Payer: Qualcare PPO/HMO/WC	$148.12

DREAMWIRE F/G .035/STIFF/450

Facility

$987.50

Hospital Charge Code	270648013
Hospital Revenue Code	272
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$493.75
Rate for Payer: Aetna Commercial	$296.25
Rate for Payer: Aetna Medicare Advantage	$296.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.81
Rate for Payer: Cigna Commercial	$493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.38
Rate for Payer: Oxford Commercial	$493.75
Rate for Payer: Qualcare PPO/HMO/WC	$148.12
Rate for Payer: UnitedHealthcare Commercial	$493.75

DREAMWIREF/G.035x260cmGuidewr

Facility

$790.00

Hospital Charge Code	643738
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DREAMWIREF/G.035x260cmGuidewr

Facility

$790.00

Hospital Charge Code	643738
Hospital Revenue Code	272
Min. Negotiated Rate	$102.70
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$237.00
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.70
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$395.00

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$2,908.10
Max. Negotiated Rate	$11,185.00
Rate for Payer: Aetna Commercial	$6,711.00
Rate for Payer: Aetna Medicare Advantage	$6,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,704.35
Rate for Payer: Cigna Commercial	$11,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,908.10
Rate for Payer: Oxford Commercial	$11,185.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50
Rate for Payer: UnitedHealthcare Commercial	$11,185.00

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$3,355.50
Max. Negotiated Rate	$3,355.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,087.50
Rate for Payer: Aetna Commercial	$4,087.50
Rate for Payer: Aetna Medicare Advantage	$4,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.38
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

DRESS/DEBRIDE, WO ANESTH;SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	2500363
Hospital Revenue Code	761
Min. Negotiated Rate	$46.08
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$106.33
Rate for Payer: Aetna Medicare Advantage	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.38
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.08
Rate for Payer: Oxford Commercial	$177.22
Rate for Payer: Qualcare PPO/HMO/WC	$53.17
Rate for Payer: UnitedHealthcare Commercial	$177.22

DRESS/DEBRIDE, WO ANESTH;SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	2500363
Hospital Revenue Code	761
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

DRESSG 2X2 STER BOX *****

Facility

$9.00

Hospital Charge Code	8000499
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DRESSG 2X2 STER BOX *****

Facility

$9.00

Hospital Charge Code	8000499
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

DRESSG 2x2 STER BX

Facility

$11.25

Hospital Charge Code	270350065
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$5.62

DRESSG 2x2 STER BX

Facility

$11.25

Hospital Charge Code	270350065
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DRESSG 3X3 BOX ******

Facility

$9.00

Hospital Charge Code	8000507
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

Know your out-of-pocket cost for care.

All Charges