Heights University Hospital

All Charges

Charge

Type

Setting

Price

RETIN-A 0.1%/20GM

Facility

$152.00

Hospital Charge Code	60633820
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

RETINOL BINDING PROTEIN

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3002364
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

RETINOL BINDING PROTEIN

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3002364
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RETINOL BINDING PROTEIN

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	39900448
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RETINOL BINDING PROTEIN

Facility

$390.00

Service Code	HCPCS 83883
Hospital Charge Code	39900448
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

RETINOL BINDING PROTEIN (RBP)

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3038118
Hospital Revenue Code	300
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

RETINOL BINDING PROTEIN (RBP)

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3038118
Hospital Revenue Code	300
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

RETRAC KELLY BLADE180MM102*51

Facility

$1,725.00

Hospital Charge Code	270665985
Hospital Revenue Code	270
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$517.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.25
Rate for Payer: Oxford Commercial	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$862.50

RETRAC KELLY BLADE180MM102*51

Facility

$1,725.00

Hospital Charge Code	270665985
Hospital Revenue Code	270
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

RETRACTA COIL MWCER-35-14-6

Facility

$3,252.45

Hospital Charge Code	270702166
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$975.74
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COIL MWCER-35-14-6

Facility

$3,252.45

Hospital Charge Code	270702166
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COIL MWCER-35-7-10

Facility

$3,252.45

Hospital Charge Code	270702164
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$975.74
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COIL MWCER-35-7-10

Facility

$3,252.45

Hospital Charge Code	270702164
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COILS MWCER-35-14-12

Facility

$3,252.45

Hospital Charge Code	270702169
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$1,626.22
Rate for Payer: Aetna Commercial	$975.74
Rate for Payer: Aetna Medicare Advantage	$975.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$829.37
Rate for Payer: Cigna Commercial	$1,626.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACTA COILS MWCER-35-14-12

Facility

$3,252.45

Hospital Charge Code	270702169
Hospital Revenue Code	278
Min. Negotiated Rate	$487.87
Max. Negotiated Rate	$787.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.09
Rate for Payer: Qualcare PPO/HMO/WC	$487.87

RETRACT ALEXIS 2.5 6CM LAP SYS

Facility

$1,000.00

Hospital Charge Code	270683713
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

RETRACT ALEXIS 2.5 6CM LAP SYS

Facility

$1,000.00

Hospital Charge Code	270683713
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

RETRACT ALEXIS 5-9 LAP SYSTEM

Facility

$1,000.00

Hospital Charge Code	270683714
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

RETRACT ALEXIS 5-9 LAP SYSTEM

Facility

$1,000.00

Hospital Charge Code	270683714
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

RETRACT KELLY BLADE180MM 76*51

Facility

$1,725.00

Hospital Charge Code	270665984
Hospital Revenue Code	270
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$517.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.25
Rate for Payer: Oxford Commercial	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$862.50

RETRACT KELLY BLADE180MM 76*51

Facility

$1,725.00

Hospital Charge Code	270665984
Hospital Revenue Code	270
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

RETRACTOR ALEXIS 5-9CM

Facility

$375.00

Hospital Charge Code	270687087
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

RETRACTOR ALEXIS 5-9CM

Facility

$375.00

Hospital Charge Code	270687087
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

RETRACTOR ALEXIX WOUND MEDIUM

Facility

$270.00

Hospital Charge Code	270688644
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

RETRACTOR ALEXIX WOUND MEDIUM

Facility

$270.00

Hospital Charge Code	270688644
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

Know your out-of-pocket cost for care.

All Charges