Heights University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE FOR OR GOWN 89791****

Facility

$4.80

Hospital Charge Code	270600162
Hospital Revenue Code	272
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$2.40
Rate for Payer: Aetna Commercial	$1.44
Rate for Payer: Aetna Medicare Advantage	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.22
Rate for Payer: Cigna Commercial	$2.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.62
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$2.40

SLEEVE FOR OR GOWN 89791****

Facility

$4.80

Hospital Charge Code	270600162
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

SLEEVE GASTRECTOMY

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600166
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

SLEEVE GASTRECTOMY

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600166
Hospital Revenue Code	361
Min. Negotiated Rate	$1,079.49
Max. Negotiated Rate	$43,374.33
Rate for Payer: Aetna Commercial	$43,374.33
Rate for Payer: Aetna Medicare Advantage	$43,374.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,000.00
Rate for Payer: Cigna Commercial	$1,079.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,795.54
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

SLEEVE GAS.W HIATAL HERNIA REP

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600167
Hospital Revenue Code	361
Min. Negotiated Rate	$1,079.49
Max. Negotiated Rate	$43,374.33
Rate for Payer: Aetna Commercial	$43,374.33
Rate for Payer: Aetna Medicare Advantage	$43,374.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,000.00
Rate for Payer: Cigna Commercial	$1,079.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,795.54
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

SLEEVE GAS.W HIATAL HERNIA REP

Facility

$144,581.09

Service Code	HCPCS 43775
Hospital Charge Code	1600167
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$91.19
Rate for Payer: Qualcare PPO/HMO/WC	$91.19

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$79.03
Max. Negotiated Rate	$303.95
Rate for Payer: Aetna Commercial	$182.37
Rate for Payer: Aetna Medicare Advantage	$182.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.01
Rate for Payer: Cigna Commercial	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.03
Rate for Payer: Oxford Commercial	$303.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.19
Rate for Payer: UnitedHealthcare Commercial	$303.95

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$249.99
Max. Negotiated Rate	$961.50
Rate for Payer: Aetna Commercial	$576.90
Rate for Payer: Aetna Medicare Advantage	$576.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.37
Rate for Payer: Cigna Commercial	$961.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.99
Rate for Payer: Oxford Commercial	$961.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.45
Rate for Payer: UnitedHealthcare Commercial	$961.50

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$288.45
Max. Negotiated Rate	$288.45
Rate for Payer: Qualcare PPO/HMO/WC	$288.45

SLEEVE IRRIGATION ASPIRATION T

Facility

$615.00

Hospital Charge Code	270655840
Hospital Revenue Code	271
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

SLEEVE IRRIGATION ASPIRATION T

Facility

$615.00

Hospital Charge Code	270655840
Hospital Revenue Code	271
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$184.50
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.82
Rate for Payer: Cigna Commercial	$307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.95
Rate for Payer: Oxford Commercial	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$307.50

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$15.29
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Medicare Advantage	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.80
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.98
Rate for Payer: Oxford Commercial	$15.29
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$15.29

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$463.12
Rate for Payer: Aetna Commercial	$277.88
Rate for Payer: Aetna Medicare Advantage	$277.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.19
Rate for Payer: Cigna Commercial	$463.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: Qualcare PPO/HMO/WC	$138.94

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$224.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: Qualcare PPO/HMO/WC	$138.94

SLEEVE PNEUMO W/PROTRC 100500

Facility

$3,793.65

Hospital Charge Code	270609480
Hospital Revenue Code	272
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$569.05
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

SLEEVE PNEUMO W/PROTRC 100500

Facility

$3,793.65

Hospital Charge Code	270609480
Hospital Revenue Code	272
Min. Negotiated Rate	$493.17
Max. Negotiated Rate	$1,896.83
Rate for Payer: Aetna Commercial	$1,138.10
Rate for Payer: Aetna Medicare Advantage	$1,138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$967.38
Rate for Payer: Cigna Commercial	$1,896.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.17
Rate for Payer: Oxford Commercial	$1,896.83
Rate for Payer: Qualcare PPO/HMO/WC	$569.05
Rate for Payer: UnitedHealthcare Commercial	$1,896.83

SLEEVE POSITIONING 10mm 113578

Facility

$985.00

Hospital Charge Code	270639969
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

SLEEVE POSITIONING 10mm 113578

Facility

$985.00

Hospital Charge Code	270639969
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$295.50
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$54.92
Max. Negotiated Rate	$211.25
Rate for Payer: Aetna Commercial	$126.75
Rate for Payer: Aetna Medicare Advantage	$126.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.74
Rate for Payer: Cigna Commercial	$211.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.92
Rate for Payer: Oxford Commercial	$211.25
Rate for Payer: Qualcare PPO/HMO/WC	$63.38
Rate for Payer: UnitedHealthcare Commercial	$211.25

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$63.38
Max. Negotiated Rate	$63.38
Rate for Payer: Qualcare PPO/HMO/WC	$63.38

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$195.00

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SLEEVE RESORB F/4.0mm SCREW

Facility

$816.00

Hospital Charge Code	270662828
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$244.80
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

Know your out-of-pocket cost for care.

All Charges