Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPHERES OPTISPHERE OSL26B

Facility

$5,925.00

Hospital Charge Code	270685240
Hospital Revenue Code	278
Min. Negotiated Rate	$888.75
Max. Negotiated Rate	$2,962.50
Rate for Payer: Cigna Commercial	$2,962.50
Rate for Payer: Aetna Commercial	$1,777.50
Rate for Payer: Aetna Medicare Advantage	$1,777.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,510.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,433.85
Rate for Payer: Qualcare PPO/HMO/WC	$888.75

SPHERES STERILE 4 PACK

Facility

$50.75

Hospital Charge Code	270681213
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$25.38
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare Advantage	$15.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.94
Rate for Payer: Cigna Commercial	$25.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$25.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.61
Rate for Payer: UnitedHealthcare Commercial	$25.38

SPHERES STERILE 4 PACK

Facility

$50.75

Hospital Charge Code	270681213
Hospital Revenue Code	272
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$7.61
Rate for Payer: Qualcare PPO/HMO/WC	$7.61

SPHINCTEROTOME***

Facility

$1,117.00

Hospital Charge Code	2300648
Hospital Revenue Code	279
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

SPHINCTEROTOME***

Facility

$1,117.00

Hospital Charge Code	2300648
Hospital Revenue Code	279
Min. Negotiated Rate	$145.21
Max. Negotiated Rate	$558.50
Rate for Payer: Aetna Commercial	$335.10
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.83
Rate for Payer: Cigna Commercial	$558.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.21
Rate for Payer: Oxford Commercial	$558.50
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$558.50

SPHINCTEROTOME 3 LUM 7F TRI25M

Facility

$697.70

Hospital Charge Code	270632003
Hospital Revenue Code	272
Min. Negotiated Rate	$104.66
Max. Negotiated Rate	$104.66
Rate for Payer: Qualcare PPO/HMO/WC	$104.66

SPHINCTEROTOME 3 LUM 7F TRI25M

Facility

$697.70

Hospital Charge Code	270632003
Hospital Revenue Code	272
Min. Negotiated Rate	$90.70
Max. Negotiated Rate	$348.85
Rate for Payer: Aetna Commercial	$209.31
Rate for Payer: Aetna Medicare Advantage	$209.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.91
Rate for Payer: Cigna Commercial	$348.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.70
Rate for Payer: Oxford Commercial	$348.85
Rate for Payer: Qualcare PPO/HMO/WC	$104.66
Rate for Payer: UnitedHealthcare Commercial	$348.85

SPHINCTEROTOME 5MM 20MM

Facility

$980.00

Hospital Charge Code	270701541
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$294.00
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

SPHINCTEROTOME 5MM 20MM

Facility

$980.00

Hospital Charge Code	270701540
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

SPHINCTEROTOME 5MM 20MM

Facility

$980.00

Hospital Charge Code	270701541
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

SPHINCTEROTOME 5MM 20MM

Facility

$980.00

Hospital Charge Code	270701540
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$294.00
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

SPHINCTEROTOME-BILLROTH DOUBLE

Facility

$1,130.00

Service Code	HCPCS C1729
Hospital Charge Code	270679383
Hospital Revenue Code	278
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$273.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.46
Rate for Payer: Qualcare PPO/HMO/WC	$169.50

SPHINCTEROTOME-BILLROTH DOUBLE

Facility

$1,130.00

Service Code	HCPCS C1729
Hospital Charge Code	270679383
Hospital Revenue Code	278
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$565.00
Rate for Payer: Aetna Commercial	$339.00
Rate for Payer: Aetna Medicare Advantage	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.15
Rate for Payer: Cigna Commercial	$565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.46
Rate for Payer: Qualcare PPO/HMO/WC	$169.50

SPHINCTEROTOME CELVER CUT 3 V

Facility

$1,925.00

Hospital Charge Code	270684735
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

SPHINCTEROTOME CELVER CUT 3 V

Facility

$1,925.00

Hospital Charge Code	270684735
Hospital Revenue Code	272
Min. Negotiated Rate	$250.25
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$577.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.25
Rate for Payer: Oxford Commercial	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$962.50

SPHINCTEROTOME CK WIRE DASH480

Facility

$1,015.25

Hospital Charge Code	270622353
Hospital Revenue Code	272
Min. Negotiated Rate	$152.29
Max. Negotiated Rate	$152.29
Rate for Payer: Qualcare PPO/HMO/WC	$152.29

SPHINCTEROTOME CK WIRE DASH480

Facility

$1,015.25

Hospital Charge Code	270622353
Hospital Revenue Code	272
Min. Negotiated Rate	$131.98
Max. Negotiated Rate	$507.62
Rate for Payer: Aetna Commercial	$304.57
Rate for Payer: Aetna Medicare Advantage	$304.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.89
Rate for Payer: Cigna Commercial	$507.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.98
Rate for Payer: Oxford Commercial	$507.62
Rate for Payer: Qualcare PPO/HMO/WC	$152.29
Rate for Payer: UnitedHealthcare Commercial	$507.62

SPHINCTEROTOME MCV 20MM 4515

Facility

$1,235.25

Hospital Charge Code	270627945
Hospital Revenue Code	272
Min. Negotiated Rate	$160.58
Max. Negotiated Rate	$617.62
Rate for Payer: Aetna Commercial	$370.57
Rate for Payer: Aetna Medicare Advantage	$370.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$314.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$314.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$314.99
Rate for Payer: Cigna Commercial	$617.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.58
Rate for Payer: Oxford Commercial	$617.62
Rate for Payer: Qualcare PPO/HMO/WC	$185.29
Rate for Payer: UnitedHealthcare Commercial	$617.62

SPHINCTEROTOME MCV 20MM 4515

Facility

$1,235.25

Hospital Charge Code	270627945
Hospital Revenue Code	272
Min. Negotiated Rate	$185.29
Max. Negotiated Rate	$185.29
Rate for Payer: Qualcare PPO/HMO/WC	$185.29

SPHINCTEROTOME MCV 20MM 4517

Facility

$1,097.25

Hospital Charge Code	270630651
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$548.62
Rate for Payer: Aetna Commercial	$329.18
Rate for Payer: Aetna Medicare Advantage	$329.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.80
Rate for Payer: Cigna Commercial	$548.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.64
Rate for Payer: Oxford Commercial	$548.62
Rate for Payer: Qualcare PPO/HMO/WC	$164.59
Rate for Payer: UnitedHealthcare Commercial	$548.62

SPHINCTEROTOME MCV 20MM 4517

Facility

$1,097.25

Hospital Charge Code	270630651
Hospital Revenue Code	272
Min. Negotiated Rate	$164.59
Max. Negotiated Rate	$164.59
Rate for Payer: Qualcare PPO/HMO/WC	$164.59

SPHINCTEROTOME WC DASH35480

Facility

$1,002.00

Hospital Charge Code	270626897
Hospital Revenue Code	272
Min. Negotiated Rate	$130.26
Max. Negotiated Rate	$501.00
Rate for Payer: Aetna Commercial	$300.60
Rate for Payer: Aetna Medicare Advantage	$300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.51
Rate for Payer: Cigna Commercial	$501.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.26
Rate for Payer: Oxford Commercial	$501.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.30
Rate for Payer: UnitedHealthcare Commercial	$501.00

SPHINCTEROTOME WC DASH35480

Facility

$1,002.00

Hospital Charge Code	270626897
Hospital Revenue Code	272
Min. Negotiated Rate	$150.30
Max. Negotiated Rate	$150.30
Rate for Payer: Qualcare PPO/HMO/WC	$150.30

SPHINCTEROTOME WC DB LMN CT25M

Facility

$649.60

Hospital Charge Code	270619889
Hospital Revenue Code	272
Min. Negotiated Rate	$84.45
Max. Negotiated Rate	$324.80
Rate for Payer: Aetna Commercial	$194.88
Rate for Payer: Aetna Medicare Advantage	$194.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.65
Rate for Payer: Cigna Commercial	$324.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.45
Rate for Payer: Oxford Commercial	$324.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.44
Rate for Payer: UnitedHealthcare Commercial	$324.80

SPHINCTEROTOME WC DB LMN CT25M

Facility

$649.60

Hospital Charge Code	270619889
Hospital Revenue Code	272
Min. Negotiated Rate	$97.44
Max. Negotiated Rate	$97.44
Rate for Payer: Qualcare PPO/HMO/WC	$97.44

Know your out-of-pocket cost for care.

All Charges