Heights University Hospital

All Charges

Charge

Type

Setting

Price

ENDO GIA 30 3.5 *********

Facility

$1,141.00

Hospital Charge Code	1603398
Hospital Revenue Code	272
Min. Negotiated Rate	$171.15
Max. Negotiated Rate	$171.15
Rate for Payer: Qualcare PPO/HMO/WC	$171.15

ENDO GIA 30 3.5 DLU

Facility

$619.00

Hospital Charge Code	270334728
Hospital Revenue Code	272
Min. Negotiated Rate	$80.47
Max. Negotiated Rate	$309.50
Rate for Payer: Aetna Commercial	$185.70
Rate for Payer: Aetna Medicare Advantage	$185.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.84
Rate for Payer: Cigna Commercial	$309.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.47
Rate for Payer: Oxford Commercial	$309.50
Rate for Payer: Qualcare PPO/HMO/WC	$92.85
Rate for Payer: UnitedHealthcare Commercial	$309.50

ENDO GIA 30 3.5 DLU

Facility

$619.00

Hospital Charge Code	270334728
Hospital Revenue Code	272
Min. Negotiated Rate	$92.85
Max. Negotiated Rate	$92.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.85

ENDO GIA 30MM CURVED TIP

Facility

$3,123.75

Service Code	HCPCS A4649
Hospital Charge Code	270697938
Hospital Revenue Code	272
Min. Negotiated Rate	$468.56
Max. Negotiated Rate	$468.56
Rate for Payer: Qualcare PPO/HMO/WC	$468.56

ENDO GIA 30MM CURVED TIP

Facility

$3,123.75

Service Code	HCPCS A4649
Hospital Charge Code	270697938
Hospital Revenue Code	272
Min. Negotiated Rate	$406.09
Max. Negotiated Rate	$1,561.88
Rate for Payer: Aetna Commercial	$937.12
Rate for Payer: Aetna Medicare Advantage	$937.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.56
Rate for Payer: Cigna Commercial	$1,561.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.09
Rate for Payer: Oxford Commercial	$1,561.88
Rate for Payer: Qualcare PPO/HMO/WC	$468.56
Rate for Payer: UnitedHealthcare Commercial	$1,561.88

ENDO GIA 60 LOAD 4.8 ********

Facility

$587.00

Hospital Charge Code	1603448
Hospital Revenue Code	272
Min. Negotiated Rate	$88.05
Max. Negotiated Rate	$88.05
Rate for Payer: Qualcare PPO/HMO/WC	$88.05

ENDO GIA 60 LOAD 4.8 ********

Facility

$587.00

Hospital Charge Code	1603448
Hospital Revenue Code	272
Min. Negotiated Rate	$76.31
Max. Negotiated Rate	$293.50
Rate for Payer: Aetna Commercial	$176.10
Rate for Payer: Aetna Medicare Advantage	$176.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.69
Rate for Payer: Cigna Commercial	$293.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.31
Rate for Payer: Oxford Commercial	$293.50
Rate for Payer: Qualcare PPO/HMO/WC	$88.05
Rate for Payer: UnitedHealthcare Commercial	$293.50

ENDO GIA II 45-2.0 SULU 030426

Facility

$410.00

Hospital Charge Code	270641755
Hospital Revenue Code	272
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

ENDO GIA II 45-2.0 SULU 030426

Facility

$410.00

Hospital Charge Code	270641755
Hospital Revenue Code	272
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$123.00
Rate for Payer: Aetna Medicare Advantage	$123.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.55
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.30
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$205.00

ENDO GIA II 60 3.5 SGS032R

Facility

$1,203.25

Hospital Charge Code	270618612
Hospital Revenue Code	272
Min. Negotiated Rate	$180.49
Max. Negotiated Rate	$180.49
Rate for Payer: Qualcare PPO/HMO/WC	$180.49

ENDO GIA II 60 3.5 SGS032R

Facility

$1,203.25

Hospital Charge Code	270618612
Hospital Revenue Code	272
Min. Negotiated Rate	$156.42
Max. Negotiated Rate	$601.62
Rate for Payer: Aetna Commercial	$360.98
Rate for Payer: Aetna Medicare Advantage	$360.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.83
Rate for Payer: Cigna Commercial	$601.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.42
Rate for Payer: Oxford Commercial	$601.62
Rate for Payer: Qualcare PPO/HMO/WC	$180.49
Rate for Payer: UnitedHealthcare Commercial	$601.62

ENDO GIA II 60 4.8 SGS035R

Facility

$1,203.25

Hospital Charge Code	270618613
Hospital Revenue Code	272
Min. Negotiated Rate	$156.42
Max. Negotiated Rate	$601.62
Rate for Payer: Aetna Commercial	$360.98
Rate for Payer: Aetna Medicare Advantage	$360.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.83
Rate for Payer: Cigna Commercial	$601.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.42
Rate for Payer: Oxford Commercial	$601.62
Rate for Payer: Qualcare PPO/HMO/WC	$180.49
Rate for Payer: UnitedHealthcare Commercial	$601.62

ENDO GIA II 60 4.8 SGS035R

Facility

$1,203.25

Hospital Charge Code	270618613
Hospital Revenue Code	272
Min. Negotiated Rate	$180.49
Max. Negotiated Rate	$180.49
Rate for Payer: Qualcare PPO/HMO/WC	$180.49

ENDO GIA LOAD UNIT 30 3.5*****

Facility

$545.00

Hospital Charge Code	1603406
Hospital Revenue Code	272
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

ENDO GIA LOAD UNIT 30 3.5*****

Facility

$545.00

Hospital Charge Code	1603406
Hospital Revenue Code	272
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$163.50
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.85
Rate for Payer: Oxford Commercial	$272.50
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Commercial	$272.50

ENDO GIA LOAD UNIT 30V******

Facility

$545.00

Hospital Charge Code	1603414
Hospital Revenue Code	272
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$163.50
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.85
Rate for Payer: Oxford Commercial	$272.50
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Commercial	$272.50

ENDO GIA LOAD UNIT 30V******

Facility

$545.00

Hospital Charge Code	1603414
Hospital Revenue Code	272
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

ENDO GIA LOAD UNIT 60 3.5 ****

Facility

$585.00

Hospital Charge Code	1603463
Hospital Revenue Code	272
Min. Negotiated Rate	$76.05
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna Commercial	$175.50
Rate for Payer: Aetna Medicare Advantage	$175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.18
Rate for Payer: Cigna Commercial	$292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.05
Rate for Payer: Oxford Commercial	$292.50
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$292.50

ENDO GIA LOAD UNIT 60 3.5 ****

Facility

$585.00

Hospital Charge Code	1603463
Hospital Revenue Code	272
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

ENDO GIA MLTFR 60 2.5

Facility

$1,680.00

Hospital Charge Code	1603489
Hospital Revenue Code	272
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$504.00
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.40
Rate for Payer: Cigna Commercial	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.40
Rate for Payer: Oxford Commercial	$840.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Commercial	$840.00

ENDO GIA MLTFR 60 2.5

Facility

$587.00

Hospital Charge Code	1603471
Hospital Revenue Code	272
Min. Negotiated Rate	$76.31
Max. Negotiated Rate	$293.50
Rate for Payer: Aetna Commercial	$176.10
Rate for Payer: Aetna Medicare Advantage	$176.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.69
Rate for Payer: Cigna Commercial	$293.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.31
Rate for Payer: Oxford Commercial	$293.50
Rate for Payer: Qualcare PPO/HMO/WC	$88.05
Rate for Payer: UnitedHealthcare Commercial	$293.50

ENDO GIA MLTFR 60 2.5

Facility

$587.00

Hospital Charge Code	1603471
Hospital Revenue Code	272
Min. Negotiated Rate	$88.05
Max. Negotiated Rate	$88.05
Rate for Payer: Qualcare PPO/HMO/WC	$88.05

ENDO GIA MLTFR 60 2.5

Facility

$1,680.00

Hospital Charge Code	1603489
Hospital Revenue Code	272
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

ENDO GIA MLTFR 60 3.5 *****

Facility

$1,680.00

Hospital Charge Code	1603455
Hospital Revenue Code	272
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$252.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

ENDO GIA MLTFR 60 3.5 *****

Facility

$1,680.00

Hospital Charge Code	1603455
Hospital Revenue Code	272
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$504.00
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.40
Rate for Payer: Cigna Commercial	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.40
Rate for Payer: Oxford Commercial	$840.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Commercial	$840.00

Know your out-of-pocket cost for care.

All Charges