Heights University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING SILVERCEL NON-AD 2x2

Facility

$16.18

Hospital Charge Code	270646631W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.43

DRESSING SILVERCEL NON-AD 4x4

Facility

$36.91

Hospital Charge Code	270646632W
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$18.45
Rate for Payer: Aetna Commercial	$11.07
Rate for Payer: Aetna Medicare Advantage	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.41
Rate for Payer: Cigna Commercial	$18.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Commercial	$18.45

DRESSING SILVERCEL NON-AD 4x4

Facility

$36.91

Hospital Charge Code	270646632W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

DRESSING SILVERLON 4X5IN

Facility

$75.00

Hospital Charge Code	270690185
Hospital Revenue Code	272
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

DRESSING SILVERLON 4X5IN

Facility

$75.00

Hospital Charge Code	270690185
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DRESSING SORBION SACHET 4x4

Facility

$27.96

Hospital Charge Code	270678124
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

DRESSING SORBION SACHET 4x4

Facility

$27.96

Hospital Charge Code	270678124
Hospital Revenue Code	272
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$13.98
Rate for Payer: Aetna Commercial	$8.39
Rate for Payer: Aetna Medicare Advantage	$8.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.13
Rate for Payer: Cigna Commercial	$13.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Oxford Commercial	$13.98
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$13.98

DRESSING SORBION SACHET 5x4

Facility

$41.98

Hospital Charge Code	270678125
Hospital Revenue Code	272
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$20.99
Rate for Payer: Aetna Commercial	$12.59
Rate for Payer: Aetna Medicare Advantage	$12.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.70
Rate for Payer: Cigna Commercial	$20.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$20.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$20.99

DRESSING SORBION SACHET 5x4

Facility

$41.98

Hospital Charge Code	270678125
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

DRESSING SORBION SACHET 8x4

Facility

$56.45

Hospital Charge Code	270678126
Hospital Revenue Code	272
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$8.47

DRESSING SORBION SACHET 8x4

Facility

$56.45

Hospital Charge Code	270678126
Hospital Revenue Code	272
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$28.23
Rate for Payer: Aetna Commercial	$16.93
Rate for Payer: Aetna Medicare Advantage	$16.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.39
Rate for Payer: Cigna Commercial	$28.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.34
Rate for Payer: Oxford Commercial	$28.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.47
Rate for Payer: UnitedHealthcare Commercial	$28.23

DRESSING SURESITE 2-3/8x2-3/4

Facility

$1.56

Hospital Charge Code	270350205
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna Commercial	$0.47
Rate for Payer: Aetna Medicare Advantage	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.40
Rate for Payer: Cigna Commercial	$0.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.20
Rate for Payer: Oxford Commercial	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.23
Rate for Payer: UnitedHealthcare Commercial	$0.78

DRESSING SURESITE 2-3/8x2-3/4

Facility

$1.56

Hospital Charge Code	270350205
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.23

DRESSING TEGADERM FORM SQ 4X4

Facility

$114.75

Hospital Charge Code	270641597
Hospital Revenue Code	270
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$17.21
Rate for Payer: Qualcare PPO/HMO/WC	$17.21

DRESSING TEGADERM FORM SQ 4X4

Facility

$114.75

Hospital Charge Code	270641597
Hospital Revenue Code	270
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$57.38
Rate for Payer: Aetna Commercial	$34.42
Rate for Payer: Aetna Medicare Advantage	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.26
Rate for Payer: Cigna Commercial	$57.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.92
Rate for Payer: Oxford Commercial	$57.38
Rate for Payer: Qualcare PPO/HMO/WC	$17.21
Rate for Payer: UnitedHealthcare Commercial	$57.38

DRESSING TELFA 4 X 3 INCH

Facility

$21.36

Hospital Charge Code	270641461
Hospital Revenue Code	272
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.20

DRESSING TELFA 4 X 3 INCH

Facility

$21.36

Hospital Charge Code	270641461
Hospital Revenue Code	272
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$10.68
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.78
Rate for Payer: Oxford Commercial	$10.68
Rate for Payer: Qualcare PPO/HMO/WC	$3.20
Rate for Payer: UnitedHealthcare Commercial	$10.68

DRESSING TELFA ISLAND 4 X 5

Facility

$2.05

Hospital Charge Code	270625585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.31

DRESSING TELFA ISLAND 4 X 5

Facility

$2.05

Hospital Charge Code	270625585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna Commercial	$0.62
Rate for Payer: Aetna Medicare Advantage	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.52
Rate for Payer: Cigna Commercial	$1.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.27
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.31
Rate for Payer: UnitedHealthcare Commercial	$1.02

DRESSING TRAC MED M6275052-5

Facility

$170.15

Hospital Charge Code	270631135
Hospital Revenue Code	272
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$85.08
Rate for Payer: Aetna Commercial	$51.05
Rate for Payer: Aetna Medicare Advantage	$51.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.39
Rate for Payer: Cigna Commercial	$85.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.12
Rate for Payer: Oxford Commercial	$85.08
Rate for Payer: Qualcare PPO/HMO/WC	$25.52
Rate for Payer: UnitedHealthcare Commercial	$85.08

DRESSING TRAC MED M6275052-5

Facility

$170.15

Hospital Charge Code	270631135
Hospital Revenue Code	272
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$25.52
Rate for Payer: Qualcare PPO/HMO/WC	$25.52

DRESSING TRANSPARENT 8X12

Facility

$47.50

Hospital Charge Code	270647396
Hospital Revenue Code	270
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.17
Rate for Payer: Oxford Commercial	$23.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$23.75

DRESSING TRANSPARENT 8X12

Facility

$47.50

Hospital Charge Code	270647396
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

DRESSING TRANSP IV 2-3/8x2-3/4

Facility

$1.05

Hospital Charge Code	270649701
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.16

DRESSING TRANSP IV 2-3/8x2-3/4

Facility

$1.05

Hospital Charge Code	270649701
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.32
Rate for Payer: Aetna Medicare Advantage	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.27
Rate for Payer: Cigna Commercial	$0.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.14
Rate for Payer: Oxford Commercial	$0.53
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.53

Know your out-of-pocket cost for care.

All Charges