Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURGILUBE TUBE

Facility

$17.89

Service Code	NDC 281020502
Hospital Charge Code	6063943249
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

SURGINEEDLE *******

Facility

$90.00

Hospital Charge Code	1608181
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SURGINEEDLE *******

Facility

$90.00

Hospital Charge Code	1608181
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

SURGINEEDLE 150MM LONG NEEDLE

Facility

$271.00

Hospital Charge Code	270334676
Hospital Revenue Code	272
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

SURGINEEDLE 150MM LONG NEEDLE

Facility

$271.00

Hospital Charge Code	270334676
Hospital Revenue Code	272
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$135.50
Rate for Payer: Aetna Commercial	$81.30
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.23
Rate for Payer: Oxford Commercial	$135.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.65
Rate for Payer: UnitedHealthcare Commercial	$135.50

SURGINEEDLE PNEUMOPERITONEUM

Facility

$491.00

Hospital Charge Code	270334675
Hospital Revenue Code	272
Min. Negotiated Rate	$63.83
Max. Negotiated Rate	$245.50
Rate for Payer: Aetna Commercial	$147.30
Rate for Payer: Aetna Medicare Advantage	$147.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.20
Rate for Payer: Cigna Commercial	$245.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.83
Rate for Payer: Oxford Commercial	$245.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.65
Rate for Payer: UnitedHealthcare Commercial	$245.50

SURGINEEDLE PNEUMOPERITONEUM

Facility

$491.00

Hospital Charge Code	270334675
Hospital Revenue Code	272
Min. Negotiated Rate	$73.65
Max. Negotiated Rate	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$73.65

SURGIPATCH 10.5MM PREM 172035

Facility

$67.25

Hospital Charge Code	270600092
Hospital Revenue Code	272
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$33.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$33.62

SURGIPATCH 10.5MM PREM 172035

Facility

$67.25

Hospital Charge Code	270600092
Hospital Revenue Code	272
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SURGIPATCH 11.5MM PREM 172037

Facility

$67.25

Hospital Charge Code	270600093
Hospital Revenue Code	272
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

SURGIPATCH 11.5MM PREM 172037

Facility

$67.25

Hospital Charge Code	270600093
Hospital Revenue Code	272
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$33.62
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$33.62

SURGIPHOR IRRIGATION SYSTEM

Facility

$7,459.35

Hospital Charge Code	270705877
Hospital Revenue Code	272
Min. Negotiated Rate	$1,118.90
Max. Negotiated Rate	$1,118.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,118.90

SURGIPHOR IRRIGATION SYSTEM

Facility

$7,459.35

Hospital Charge Code	270705877
Hospital Revenue Code	272
Min. Negotiated Rate	$969.72
Max. Negotiated Rate	$3,729.68
Rate for Payer: Aetna Commercial	$2,237.80
Rate for Payer: Aetna Medicare Advantage	$2,237.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,902.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,902.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,902.13
Rate for Payer: Cigna Commercial	$3,729.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$969.72
Rate for Payer: Oxford Commercial	$3,729.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,118.90
Rate for Payer: UnitedHealthcare Commercial	$3,729.68

SURGIPORT 11MM *****

Facility

$382.00

Hospital Charge Code	1603240
Hospital Revenue Code	272
Min. Negotiated Rate	$49.66
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$114.60
Rate for Payer: Aetna Medicare Advantage	$114.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.41
Rate for Payer: Cigna Commercial	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.66
Rate for Payer: Oxford Commercial	$191.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.30
Rate for Payer: UnitedHealthcare Commercial	$191.00

SURGIPORT 11MM *****

Facility

$382.00

Hospital Charge Code	1603240
Hospital Revenue Code	272
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$57.30
Rate for Payer: Qualcare PPO/HMO/WC	$57.30

SURGIPORT 12MM *****

Facility

$421.00

Hospital Charge Code	1606011
Hospital Revenue Code	272
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$126.30
Rate for Payer: Aetna Medicare Advantage	$126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.36
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.73
Rate for Payer: Oxford Commercial	$210.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$210.50

SURGIPORT 12MM *****

Facility

$398.00

Hospital Charge Code	1603265
Hospital Revenue Code	272
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$59.70
Rate for Payer: Qualcare PPO/HMO/WC	$59.70

SURGIPORT 12MM *****

Facility

$421.00

Hospital Charge Code	1606011
Hospital Revenue Code	272
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SURGIPORT 12MM *****

Facility

$398.00

Hospital Charge Code	1603265
Hospital Revenue Code	272
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$199.00
Rate for Payer: Aetna Commercial	$119.40
Rate for Payer: Aetna Medicare Advantage	$119.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.49
Rate for Payer: Cigna Commercial	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.74
Rate for Payer: Oxford Commercial	$199.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.70
Rate for Payer: UnitedHealthcare Commercial	$199.00

SURGIPORT 15MM *****

Facility

$414.00

Hospital Charge Code	1603257
Hospital Revenue Code	272
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$124.20
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Oxford Commercial	$207.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$207.00

SURGIPORT 15MM *****

Facility

$414.00

Hospital Charge Code	1603257
Hospital Revenue Code	272
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

SURGIPORT CONVERTOR 5.5/15MM**

Facility

$29.00

Hospital Charge Code	1603356
Hospital Revenue Code	272
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna Commercial	$8.70
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.39
Rate for Payer: Cigna Commercial	$14.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.77
Rate for Payer: Oxford Commercial	$14.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$14.50

SURGIPORT CONVERTOR 5.5/15MM**

Facility

$29.00

Hospital Charge Code	1603356
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

SURGIPORT CONVERTR 10.5/15MM**

Facility

$27.00

Hospital Charge Code	1603349
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

SURGIPORT CONVERTR 10.5/15MM**

Facility

$27.00

Hospital Charge Code	1603349
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

Know your out-of-pocket cost for care.

All Charges