Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACTOR STONE HEL S 4.5

Facility

$864.85

Hospital Charge Code	270605391
Hospital Revenue Code	272
Min. Negotiated Rate	$112.43
Max. Negotiated Rate	$432.43
Rate for Payer: Aetna Commercial	$259.45
Rate for Payer: Aetna Medicare Advantage	$259.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.54
Rate for Payer: Cigna Commercial	$432.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.43
Rate for Payer: Oxford Commercial	$432.43
Rate for Payer: Qualcare PPO/HMO/WC	$129.73
Rate for Payer: UnitedHealthcare Commercial	$432.43

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$133.77
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$308.70
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.77
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Commercial	$514.50

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$154.35
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$156.61
Max. Negotiated Rate	$156.61
Rate for Payer: Qualcare PPO/HMO/WC	$156.61

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$135.73
Max. Negotiated Rate	$522.02
Rate for Payer: Aetna Commercial	$313.21
Rate for Payer: Aetna Medicare Advantage	$313.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.23
Rate for Payer: Cigna Commercial	$522.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.73
Rate for Payer: Oxford Commercial	$522.02
Rate for Payer: Qualcare PPO/HMO/WC	$156.61
Rate for Payer: UnitedHealthcare Commercial	$522.02

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$61.42
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Commercial	$141.75
Rate for Payer: Aetna Medicare Advantage	$141.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.49
Rate for Payer: Cigna Commercial	$236.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.42
Rate for Payer: Oxford Commercial	$236.25
Rate for Payer: Qualcare PPO/HMO/WC	$70.88
Rate for Payer: UnitedHealthcare Commercial	$236.25

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$70.88
Rate for Payer: Qualcare PPO/HMO/WC	$70.88

EXTRACTOR STONE RETR XL 5

Facility

$1,024.85

Hospital Charge Code	270604771
Hospital Revenue Code	272
Min. Negotiated Rate	$133.23
Max. Negotiated Rate	$512.42
Rate for Payer: Aetna Commercial	$307.45
Rate for Payer: Aetna Medicare Advantage	$307.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.34
Rate for Payer: Cigna Commercial	$512.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.23
Rate for Payer: Oxford Commercial	$512.42
Rate for Payer: Qualcare PPO/HMO/WC	$153.73
Rate for Payer: UnitedHealthcare Commercial	$512.42

EXTRACTOR STONE RETR XL 5

Facility

$1,024.85

Hospital Charge Code	270604771
Hospital Revenue Code	272
Min. Negotiated Rate	$153.73
Max. Negotiated Rate	$153.73
Rate for Payer: Qualcare PPO/HMO/WC	$153.73

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$275.00

EXTRACTOR STONE RETR XL 7 5047

Facility

$1,024.85

Hospital Charge Code	270604773
Hospital Revenue Code	272
Min. Negotiated Rate	$133.23
Max. Negotiated Rate	$512.42
Rate for Payer: Aetna Commercial	$307.45
Rate for Payer: Aetna Medicare Advantage	$307.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.34
Rate for Payer: Cigna Commercial	$512.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.23
Rate for Payer: Oxford Commercial	$512.42
Rate for Payer: Qualcare PPO/HMO/WC	$153.73
Rate for Payer: UnitedHealthcare Commercial	$512.42

EXTRACTOR STONE RETR XL 7 5047

Facility

$1,024.85

Hospital Charge Code	270604773
Hospital Revenue Code	272
Min. Negotiated Rate	$153.73
Max. Negotiated Rate	$153.73
Rate for Payer: Qualcare PPO/HMO/WC	$153.73

EXTRACTOR WC STONE 12MM TXR12A

Facility

$591.85

Hospital Charge Code	270623616
Hospital Revenue Code	272
Min. Negotiated Rate	$76.94
Max. Negotiated Rate	$295.93
Rate for Payer: Aetna Commercial	$177.56
Rate for Payer: Aetna Medicare Advantage	$177.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.92
Rate for Payer: Cigna Commercial	$295.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.94
Rate for Payer: Oxford Commercial	$295.93
Rate for Payer: Qualcare PPO/HMO/WC	$88.78
Rate for Payer: UnitedHealthcare Commercial	$295.93

EXTRACTOR WC STONE 12MM TXR12A

Facility

$591.85

Hospital Charge Code	270623616
Hospital Revenue Code	272
Min. Negotiated Rate	$88.78
Max. Negotiated Rate	$88.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.78

EXTRACTOR WC STONE 15MM TXR15A

Facility

$591.85

Hospital Charge Code	270623617
Hospital Revenue Code	272
Min. Negotiated Rate	$76.94
Max. Negotiated Rate	$295.93
Rate for Payer: Aetna Commercial	$177.56
Rate for Payer: Aetna Medicare Advantage	$177.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.92
Rate for Payer: Cigna Commercial	$295.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.94
Rate for Payer: Oxford Commercial	$295.93
Rate for Payer: Qualcare PPO/HMO/WC	$88.78
Rate for Payer: UnitedHealthcare Commercial	$295.93

EXTRACTOR WC STONE 15MM TXR15A

Facility

$591.85

Hospital Charge Code	270623617
Hospital Revenue Code	272
Min. Negotiated Rate	$88.78
Max. Negotiated Rate	$88.78
Rate for Payer: Qualcare PPO/HMO/WC	$88.78

EXTRACTOR WC STONE 3F 013300

Facility

$1,015.25

Hospital Charge Code	270601101
Hospital Revenue Code	272
Min. Negotiated Rate	$131.98
Max. Negotiated Rate	$507.62
Rate for Payer: Aetna Commercial	$304.57
Rate for Payer: Aetna Medicare Advantage	$304.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.89
Rate for Payer: Cigna Commercial	$507.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.98
Rate for Payer: Oxford Commercial	$507.62
Rate for Payer: Qualcare PPO/HMO/WC	$152.29
Rate for Payer: UnitedHealthcare Commercial	$507.62

EXTRACTOR WC STONE 3F 013300

Facility

$1,015.25

Hospital Charge Code	270601101
Hospital Revenue Code	272
Min. Negotiated Rate	$152.29
Max. Negotiated Rate	$152.29
Rate for Payer: Qualcare PPO/HMO/WC	$152.29

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

EXTRACTRSTRIPSCREW4MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695332
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTRSTRIPSCREW4MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695332
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$56,373.84

Service Code	MSDRG 115
Min. Negotiated Rate	$16,749.72
Max. Negotiated Rate	$56,373.84
Rate for Payer: Aetna Commercial	$51,756.63
Rate for Payer: Aetna Medicare Advantage	$16,749.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,004.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,004.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,791.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,004.52
Rate for Payer: Cigna Commercial	$33,032.58
Rate for Payer: Cigna Medicare Advantage	$18,791.28
Rate for Payer: Clover Medicare Advantage	$17,851.72
Rate for Payer: EmblemHealth Commercial	$56,373.84
Rate for Payer: Humana Medicare Advantage	$19,355.02
Rate for Payer: Oxford Commercial	$20,644.40
Rate for Payer: UnitedHealthcare Commercial	$23,433.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,791.28
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19,918.76
Rate for Payer: Wellcare Medicare Advantage	$18,791.28

EXTRCTR PRO RPD 15-18M00547020

Facility

$742.00

Hospital Charge Code	270646921
Hospital Revenue Code	272
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$111.30
Rate for Payer: Qualcare PPO/HMO/WC	$111.30

Know your out-of-pocket cost for care.

All Charges