Heights University Hospital

All Charges

Charge

Type

Setting

Price

LAPAROSCOPY LYMPHADENECTOMY

Facility

$33,033.35

Service Code	HCPCS 38572
Hospital Charge Code	1600000516
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$9,910.00
Rate for Payer: Aetna Medicare Advantage	$9,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,423.50
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,294.34
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,955.00
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAPAROSCOPY SPLENECTOMY

Facility

$61,304.40

Service Code	HCPCS 38120
Hospital Charge Code	1600000676
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Aetna Commercial	$18,391.32
Rate for Payer: Aetna Medicare Advantage	$18,391.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,632.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,632.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,632.62
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,969.57
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,195.66
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAPAROSCOPY SPLENECTOMY

Facility

$61,304.40

Service Code	HCPCS 38120
Hospital Charge Code	1600000676
Hospital Revenue Code	360
Min. Negotiated Rate	$9,195.66
Max. Negotiated Rate	$9,195.66
Rate for Payer: Qualcare PPO/HMO/WC	$9,195.66

LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE

Facility

$14,396.79

Service Code	CPT 55550
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,396.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$25,313.84

Service Code	CPT 58554
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$25,313.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAPAROSCPIC MYOMECTMY =<250 GM

Facility

$34,812.50

Service Code	HCPCS 58545
Hospital Charge Code	16000761
Hospital Revenue Code	360
Min. Negotiated Rate	$5,221.88
Max. Negotiated Rate	$5,221.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,221.88

LAPAROSCPIC MYOMECTMY =<250 GM

Facility

$34,812.50

Service Code	HCPCS 58545
Hospital Charge Code	16000761
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,396.79
Rate for Payer: Aetna Commercial	$10,443.75
Rate for Payer: Aetna Medicare Advantage	$10,443.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,877.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,877.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,877.19
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,525.62
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,221.88
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

LAPARO SLING OPERATION

Facility

$21,530.28

Service Code	HCPCS 51992
Hospital Charge Code	16000997
Hospital Revenue Code	360
Min. Negotiated Rate	$3,229.54
Max. Negotiated Rate	$3,229.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54

LAPARO SLING OPERATION

Facility

$21,530.28

Service Code	HCPCS 51992
Hospital Charge Code	16000997
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,396.79
Rate for Payer: Aetna Commercial	$6,459.08
Rate for Payer: Aetna Medicare Advantage	$6,459.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,490.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,490.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,490.22
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,798.94
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAPAROS,W LYSIS OF ADHESIONS

Facility

$43,334.60

Service Code	HCPCS 58660
Hospital Charge Code	160000180
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.19
Max. Negotiated Rate	$6,500.19
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19

LAPAROS,W LYSIS OF ADHESIONS

Facility

$43,334.60

Service Code	HCPCS 58660
Hospital Charge Code	160000180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$14,396.79
Rate for Payer: Aetna Commercial	$13,000.38
Rate for Payer: Aetna Medicare Advantage	$13,000.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,050.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,050.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,050.32
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,633.50
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

LAP BAND AP SYS STD W/LOW PROF

Facility

$17,975.00

Hospital Charge Code	270664441
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

LAP BAND AP SYS STD W/LOW PROF

Facility

$17,975.00

Hospital Charge Code	270664441
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAP-BAND AP SYSTEM STANDARD AP

Facility

$18,875.00

Hospital Charge Code	27064441
Hospital Revenue Code	272
Min. Negotiated Rate	$2,453.75
Max. Negotiated Rate	$9,437.50
Rate for Payer: Aetna Commercial	$5,662.50
Rate for Payer: Aetna Medicare Advantage	$5,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,813.12
Rate for Payer: Cigna Commercial	$9,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.75
Rate for Payer: Oxford Commercial	$9,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,831.25
Rate for Payer: UnitedHealthcare Commercial	$9,437.50

LAP-BAND AP SYSTEM STANDARD AP

Facility

$18,875.00

Hospital Charge Code	27064441
Hospital Revenue Code	272
Min. Negotiated Rate	$2,831.25
Max. Negotiated Rate	$2,831.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,831.25

LAP BAND LG STD LOW PROFILE 14

Facility

$17,975.00

Hospital Charge Code	270662076
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAP BAND LG STD LOW PROFILE 14

Facility

$17,975.00

Hospital Charge Code	270662076
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

LAP BAND PORT 1 LG STD 14CC

Facility

$17,975.00

Hospital Charge Code	270662079
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

LAP BAND PORT 1 LG STD 14CC

Facility

$17,975.00

Hospital Charge Code	270662079
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAP BAND PORT 2 LOW PROFILE ST

Facility

$17,975.00

Hospital Charge Code	270662075
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAP BAND PORT 2 LOW PROFILE ST

Facility

$17,975.00

Hospital Charge Code	S2083
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAP BAND PORT 2 LOW PROFILE ST

Facility

$17,975.00

Hospital Charge Code	270662075
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

LAP BAND PORT 2 LOW PROFILE ST

Facility

$17,975.00

Hospital Charge Code	S2083
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

LAPBAND W/ACS PRT 0-10 APS2240

Facility

$17,975.00

Hospital Charge Code	270641066
Hospital Revenue Code	272
Min. Negotiated Rate	$2,336.75
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.75
Rate for Payer: Oxford Commercial	$8,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Commercial	$8,987.50

LAPBAND W/ACS PRT 0-10 APS2240

Facility

$17,975.00

Hospital Charge Code	270641066
Hospital Revenue Code	272
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$2,696.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

Know your out-of-pocket cost for care.

All Charges