Heights University Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR ENDO 10MM STD LGTH

Facility

$364.34

Hospital Charge Code	270667606
Hospital Revenue Code	272
Min. Negotiated Rate	$54.65
Max. Negotiated Rate	$54.65
Rate for Payer: Qualcare PPO/HMO/WC	$54.65

RETRACTOR ENDO 12MM LOR12

Facility

$1,228.85

Hospital Charge Code	270608761
Hospital Revenue Code	272
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$614.42
Rate for Payer: Aetna Commercial	$368.65
Rate for Payer: Aetna Medicare Advantage	$368.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$313.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$313.36
Rate for Payer: Cigna Commercial	$614.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.75
Rate for Payer: Oxford Commercial	$614.42
Rate for Payer: Qualcare PPO/HMO/WC	$184.33
Rate for Payer: UnitedHealthcare Commercial	$614.42

RETRACTOR ENDO 12MM LOR12

Facility

$1,228.85

Hospital Charge Code	270608761
Hospital Revenue Code	272
Min. Negotiated Rate	$184.33
Max. Negotiated Rate	$184.33
Rate for Payer: Qualcare PPO/HMO/WC	$184.33

RETRACTOR ENDO PADDLE 12MM

Facility

$2,006.25

Hospital Charge Code	270641076
Hospital Revenue Code	272
Min. Negotiated Rate	$260.81
Max. Negotiated Rate	$1,003.12
Rate for Payer: Aetna Commercial	$601.88
Rate for Payer: Aetna Medicare Advantage	$601.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.59
Rate for Payer: Cigna Commercial	$1,003.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.81
Rate for Payer: Oxford Commercial	$1,003.12
Rate for Payer: Qualcare PPO/HMO/WC	$300.94
Rate for Payer: UnitedHealthcare Commercial	$1,003.12

RETRACTOR ENDO PADDLE 12MM

Facility

$2,006.25

Hospital Charge Code	270641076
Hospital Revenue Code	272
Min. Negotiated Rate	$300.94
Max. Negotiated Rate	$300.94
Rate for Payer: Qualcare PPO/HMO/WC	$300.94

RETRACTOR HOHMANN 15MMx160MM

Facility

$1,117.15

Hospital Charge Code	270608594
Hospital Revenue Code	272
Min. Negotiated Rate	$145.23
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$335.14
Rate for Payer: Aetna Medicare Advantage	$335.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.87
Rate for Payer: Cigna Commercial	$558.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.23
Rate for Payer: Oxford Commercial	$558.58
Rate for Payer: Qualcare PPO/HMO/WC	$167.57
Rate for Payer: UnitedHealthcare Commercial	$558.58

RETRACTOR HOHMANN 15MMx160MM

Facility

$1,117.15

Hospital Charge Code	270608594
Hospital Revenue Code	272
Min. Negotiated Rate	$167.57
Max. Negotiated Rate	$167.57
Rate for Payer: Qualcare PPO/HMO/WC	$167.57

RETRACTOR HOHMANN 24 MM BLADE

Facility

$396.85

Hospital Charge Code	270681333
Hospital Revenue Code	272
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$59.53
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

RETRACTOR HOHMANN 24 MM BLADE

Facility

$396.85

Hospital Charge Code	270681333
Hospital Revenue Code	272
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$198.43
Rate for Payer: Aetna Commercial	$119.06
Rate for Payer: Aetna Medicare Advantage	$119.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.20
Rate for Payer: Cigna Commercial	$198.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.59
Rate for Payer: Oxford Commercial	$198.43
Rate for Payer: Qualcare PPO/HMO/WC	$59.53
Rate for Payer: UnitedHealthcare Commercial	$198.43

RETRACTOR HOHMANN 6mmX160mm

Facility

$903.90

Hospital Charge Code	270638980
Hospital Revenue Code	272
Min. Negotiated Rate	$117.51
Max. Negotiated Rate	$451.95
Rate for Payer: Aetna Commercial	$271.17
Rate for Payer: Aetna Medicare Advantage	$271.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.49
Rate for Payer: Cigna Commercial	$451.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.51
Rate for Payer: Oxford Commercial	$451.95
Rate for Payer: Qualcare PPO/HMO/WC	$135.59
Rate for Payer: UnitedHealthcare Commercial	$451.95

RETRACTOR HOHMANN 6mmX160mm

Facility

$903.90

Hospital Charge Code	270638980
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$117.51
Max. Negotiated Rate	$451.95
Rate for Payer: Aetna Commercial	$271.17
Rate for Payer: Aetna Medicare Advantage	$271.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.49
Rate for Payer: Cigna Commercial	$451.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.51
Rate for Payer: Oxford Commercial	$451.95
Rate for Payer: Qualcare PPO/HMO/WC	$135.59
Rate for Payer: UnitedHealthcare Commercial	$451.95

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$3,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$3,315.00
Max. Negotiated Rate	$12,750.00
Rate for Payer: Aetna Commercial	$7,650.00
Rate for Payer: Aetna Medicare Advantage	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,502.50
Rate for Payer: Cigna Commercial	$12,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,315.00
Rate for Payer: Oxford Commercial	$12,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00
Rate for Payer: UnitedHealthcare Commercial	$12,750.00

RETRACTOR KIT *********

Facility

$259.00

Hospital Charge Code	1608512
Hospital Revenue Code	272
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

RETRACTOR KIT *********

Facility

$259.00

Hospital Charge Code	1608512
Hospital Revenue Code	272
Min. Negotiated Rate	$33.67
Max. Negotiated Rate	$129.50
Rate for Payer: Aetna Commercial	$77.70
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.67
Rate for Payer: Oxford Commercial	$129.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$129.50

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$83.98

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$72.79
Max. Negotiated Rate	$279.95
Rate for Payer: Aetna Commercial	$167.97
Rate for Payer: Aetna Medicare Advantage	$167.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.77
Rate for Payer: Cigna Commercial	$279.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.79
Rate for Payer: Oxford Commercial	$279.95
Rate for Payer: Qualcare PPO/HMO/WC	$83.98
Rate for Payer: UnitedHealthcare Commercial	$279.95

RETRACTOR LARGE HASSANS

Facility

$442.80

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$66.42
Rate for Payer: Qualcare PPO/HMO/WC	$66.42

RETRACTOR LARGE HASSANS

Facility

$442.80

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$57.56
Max. Negotiated Rate	$221.40
Rate for Payer: Aetna Commercial	$132.84
Rate for Payer: Aetna Medicare Advantage	$132.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.91
Rate for Payer: Cigna Commercial	$221.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.56
Rate for Payer: Oxford Commercial	$221.40
Rate for Payer: Qualcare PPO/HMO/WC	$66.42
Rate for Payer: UnitedHealthcare Commercial	$221.40

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$142.60
Max. Negotiated Rate	$548.48
Rate for Payer: Aetna Commercial	$329.08
Rate for Payer: Aetna Medicare Advantage	$329.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.72
Rate for Payer: Cigna Commercial	$548.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.60
Rate for Payer: Oxford Commercial	$548.48
Rate for Payer: Qualcare PPO/HMO/WC	$164.54
Rate for Payer: UnitedHealthcare Commercial	$548.48

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$164.54
Max. Negotiated Rate	$164.54
Rate for Payer: Qualcare PPO/HMO/WC	$164.54

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$50.19
Max. Negotiated Rate	$193.05
Rate for Payer: Aetna Commercial	$115.83
Rate for Payer: Aetna Medicare Advantage	$115.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.46
Rate for Payer: Cigna Commercial	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.19
Rate for Payer: Oxford Commercial	$193.05
Rate for Payer: Qualcare PPO/HMO/WC	$57.91
Rate for Payer: UnitedHealthcare Commercial	$193.05

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$57.91
Rate for Payer: Qualcare PPO/HMO/WC	$57.91

Know your out-of-pocket cost for care.

All Charges