Heights University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING AQUACEL AG 9x15cm

Facility

$123.48

Hospital Charge Code	270666440
Hospital Revenue Code	272
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

DRESSING AQUACEL FOAM 4x4

Facility

$17.03

Hospital Charge Code	270649177
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.52
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$5.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.34
Rate for Payer: Cigna Commercial	$8.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.52

DRESSING AQUACEL FOAM 4x4

Facility

$17.03

Hospital Charge Code	270649177
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

DRESSING AQUACEL FOAM 5x5

Facility

$30.86

Hospital Charge Code	270420619
Hospital Revenue Code	272
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$15.43
Rate for Payer: Aetna Commercial	$9.26
Rate for Payer: Aetna Medicare Advantage	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.87
Rate for Payer: Cigna Commercial	$15.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.01
Rate for Payer: Oxford Commercial	$15.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.63
Rate for Payer: UnitedHealthcare Commercial	$15.43

DRESSING AQUACEL FOAM 5x5

Facility

$30.86

Hospital Charge Code	270420619
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

DRESSING AQUACEL FOAM 7x7

Facility

$53.40

Hospital Charge Code	270420621
Hospital Revenue Code	272
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$8.01

DRESSING AQUACEL FOAM 7x7

Facility

$53.40

Hospital Charge Code	270420621
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$26.70
Rate for Payer: Aetna Commercial	$16.02
Rate for Payer: Aetna Medicare Advantage	$16.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.62
Rate for Payer: Cigna Commercial	$26.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.94
Rate for Payer: Oxford Commercial	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.01
Rate for Payer: UnitedHealthcare Commercial	$26.70

DRESSING AQUACL 6x6 1638403710

Facility

$30.12

Hospital Charge Code	270350295
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$15.06
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.92
Rate for Payer: Oxford Commercial	$15.06
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$15.06

DRESSING AQUACL 6x6 1638403710

Facility

$30.12

Hospital Charge Code	270350295
Hospital Revenue Code	272
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

DRESSING BANDAGE ROLL STRETCHD

Facility

$7.60

Hospital Charge Code	270650292
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.94
Rate for Payer: Cigna Commercial	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.14
Rate for Payer: UnitedHealthcare Commercial	$3.80

DRESSING BANDAGE ROLL STRETCHD

Facility

$7.60

Hospital Charge Code	270650292
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.14

DRESSING BANDAGE SPANDAGE SZ.2

Facility

$239.00

Hospital Charge Code	270650558
Hospital Revenue Code	270
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$71.70
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Oxford Commercial	$119.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$119.50

DRESSING BANDAGE SPANDAGE SZ.2

Facility

$239.00

Hospital Charge Code	270650558
Hospital Revenue Code	270
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

DRESSING BANDAGE SPANDAGE SZ.4

Facility

$80.60

Hospital Charge Code	270650559
Hospital Revenue Code	270
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$40.30
Rate for Payer: Aetna Commercial	$24.18
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.55
Rate for Payer: Cigna Commercial	$40.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.48
Rate for Payer: Oxford Commercial	$40.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.09
Rate for Payer: UnitedHealthcare Commercial	$40.30

DRESSING BANDAGE SPANDAGE SZ.4

Facility

$80.60

Hospital Charge Code	270650559
Hospital Revenue Code	270
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$12.09

DRESSING BANDAGE SPANDAGE SZ.8

Facility

$111.25

Hospital Charge Code	270649757
Hospital Revenue Code	270
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

DRESSING BANDAGE SPANDAGE SZ.8

Facility

$111.25

Hospital Charge Code	270649757
Hospital Revenue Code	270
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$33.38
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.46
Rate for Payer: Oxford Commercial	$55.62
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$55.62

DRESSING BILAYER MATRIX 2X2

Facility

$7,815.00

Service Code	HCPCS Q4104
Hospital Charge Code	270636417
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$2,344.50
Rate for Payer: Aetna Commercial	$2,344.50
Rate for Payer: Aetna Medicare Advantage	$2,344.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,992.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,992.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,563.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,992.83
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,891.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,172.25

DRESSING BILAYER MATRIX 2X2

Facility

$7,815.00

Service Code	HCPCS Q4104
Hospital Charge Code	270636417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.25
Max. Negotiated Rate	$1,891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,563.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,891.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,172.25

DRESSING BIOPATCH 1 IN 4150

Facility

$43.75

Hospital Charge Code	270350300N
Hospital Revenue Code	272
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$21.88
Rate for Payer: Aetna Commercial	$13.12
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.16
Rate for Payer: Cigna Commercial	$21.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.69
Rate for Payer: Oxford Commercial	$21.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.56
Rate for Payer: UnitedHealthcare Commercial	$21.88

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300R
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300R
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.49

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.49

DRESSING BIOPATCH 1 IN 4150

Facility

$43.75

Hospital Charge Code	270350300N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$6.56
Rate for Payer: Qualcare PPO/HMO/WC	$6.56

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

Know your out-of-pocket cost for care.

All Charges