Heights University Hospital

All Charges

Charge

Type

Setting

Price

RELOAD STAPLER GREEN 45

Facility

$900.00

Hospital Charge Code	270666136
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$84.69
Max. Negotiated Rate	$325.73
Rate for Payer: Aetna Commercial	$195.44
Rate for Payer: Aetna Medicare Advantage	$195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.12
Rate for Payer: Cigna Commercial	$325.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.69
Rate for Payer: Oxford Commercial	$325.73
Rate for Payer: Qualcare PPO/HMO/WC	$97.72
Rate for Payer: UnitedHealthcare Commercial	$325.73

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$97.72
Max. Negotiated Rate	$97.72
Rate for Payer: Qualcare PPO/HMO/WC	$97.72

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$2,070.00
Max. Negotiated Rate	$2,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$1,794.00
Max. Negotiated Rate	$6,900.00
Rate for Payer: Aetna Commercial	$4,140.00
Rate for Payer: Aetna Medicare Advantage	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,519.00
Rate for Payer: Cigna Commercial	$6,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.00
Rate for Payer: Oxford Commercial	$6,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00
Rate for Payer: UnitedHealthcare Commercial	$6,900.00

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$149.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Oxford Commercial	$575.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$575.00

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$149.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Oxford Commercial	$575.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$575.00

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$149.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Oxford Commercial	$575.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$575.00

RELOAD UNIT ENDO GIA 60 MULTIF

Facility

$656.00

Hospital Charge Code	270335156
Hospital Revenue Code	272
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$328.00
Rate for Payer: Aetna Commercial	$196.80
Rate for Payer: Aetna Medicare Advantage	$196.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.28
Rate for Payer: Cigna Commercial	$328.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.28
Rate for Payer: Oxford Commercial	$328.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.40
Rate for Payer: UnitedHealthcare Commercial	$328.00

RELOAD UNIT ENDO GIA 60 MULTIF

Facility

$656.00

Hospital Charge Code	270335156
Hospital Revenue Code	272
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$98.40

RELOAD VAS. STAPLER 30MM

Facility

$82.00

Hospital Charge Code	270338701
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

RELOAD VAS. STAPLER 30MM

Facility

$82.00

Hospital Charge Code	270338701
Hospital Revenue Code	272
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$24.60
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$41.00

REM ANT SEGMENT INSTRUMENT

Facility

$12,585.60

Service Code	HCPCS 22855
Hospital Charge Code	1600000451
Hospital Revenue Code	360
Min. Negotiated Rate	$1,636.13
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$3,775.68
Rate for Payer: Aetna Medicare Advantage	$3,775.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,209.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,209.33
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	$3,209.33
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,636.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.84
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

REM ANT SEGMENT INSTRUMENT

Facility

$12,585.60

Service Code	HCPCS 22855
Hospital Charge Code	1600000451
Hospital Revenue Code	360
Min. Negotiated Rate	$1,887.84
Max. Negotiated Rate	$1,887.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.84

REM COREAL FB W/O SLIT LAM

Facility

$440.10

Service Code	HCPCS 65220
Hospital Charge Code	5780245
Hospital Revenue Code	450
Min. Negotiated Rate	$66.02
Max. Negotiated Rate	$66.02
Rate for Payer: Qualcare PPO/HMO/WC	$66.02

REM COREAL FB W/O SLIT LAM

Facility

$440.10

Service Code	HCPCS 65220
Hospital Charge Code	5780245
Hospital Revenue Code	450
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$1,063.82
Rate for Payer: Aetna Commercial	$132.03
Rate for Payer: Aetna Medicare Advantage	$132.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.23
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.21
Rate for Payer: Qualcare PPO/HMO/WC	$66.02

REM DEEP FB THIGH OR KNEE

Facility

$20,625.50

Service Code	HCPCS 27372
Hospital Charge Code	1600000331
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

REM DEEP FB THIGH OR KNEE

Facility

$20,625.50

Service Code	HCPCS 27372
Hospital Charge Code	1600000331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$6,917.28
Rate for Payer: Aetna Commercial	$6,187.65
Rate for Payer: Aetna Medicare Advantage	$6,187.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,259.50
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	$5,259.50
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,681.32
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

REMEDY MOISTURE BARRIER 4oz

Facility

$12.99

Hospital Charge Code	270302495W
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

REMEDY MOISTURE BARRIER 4oz

Facility

$12.99

Hospital Charge Code	270302495W
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

Know your out-of-pocket cost for care.

All Charges