Heights University Hospital

All Charges

Charge

Type

Setting

Price

FLOGRAFT XL

Facility

$14,875.00

Hospital Charge Code	270663892
Hospital Revenue Code	272
Min. Negotiated Rate	$1,933.75
Max. Negotiated Rate	$7,437.50
Rate for Payer: Aetna Commercial	$4,462.50
Rate for Payer: Aetna Medicare Advantage	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.12
Rate for Payer: Cigna Commercial	$7,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.75
Rate for Payer: Oxford Commercial	$7,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,231.25
Rate for Payer: UnitedHealthcare Commercial	$7,437.50

FLOGRAFT XL

Facility

$14,875.00

Hospital Charge Code	270663892
Hospital Revenue Code	272
Min. Negotiated Rate	$2,231.25
Max. Negotiated Rate	$2,231.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,231.25

FLONASE .05% SPRAY

Facility

$564.94

Service Code	NDC 50383070016
Hospital Charge Code	60629341
Hospital Revenue Code	250
Min. Negotiated Rate	$84.74
Max. Negotiated Rate	$84.74
Rate for Payer: Qualcare PPO/HMO/WC	$84.74

FLONASE .05% SPRAY

Facility

$564.94

Service Code	NDC 50383070016
Hospital Charge Code	60629341
Hospital Revenue Code	250
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$282.47
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$169.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.06
Rate for Payer: Cigna Commercial	$282.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.44
Rate for Payer: Oxford Commercial	$282.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.74
Rate for Payer: UnitedHealthcare Commercial	$282.47

FLORASTOR 250MG CAP

Facility

$6.63

Service Code	NDC 4142000007
Hospital Charge Code	60635700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

FLORASTOR 250MG CAP

Facility

$6.63

Service Code	NDC 4142000007
Hospital Charge Code	60635700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$1.99
Rate for Payer: Aetna Medicare Advantage	$1.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.69
Rate for Payer: Cigna Commercial	$3.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.86
Rate for Payer: Oxford Commercial	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$3.31

FLOSEAL HEMOSTATIC MATRIX 10 M

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	670680120
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$373.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10 M

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	670680120
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$770.84
Rate for Payer: Aetna Commercial	$462.50
Rate for Payer: Aetna Medicare Advantage	$462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.13
Rate for Payer: Cigna Commercial	$770.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270680120
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$373.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270680120
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$770.84
Rate for Payer: Aetna Commercial	$462.50
Rate for Payer: Aetna Medicare Advantage	$462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.13
Rate for Payer: Cigna Commercial	$770.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270659236
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$373.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270659236
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$770.84
Rate for Payer: Aetna Commercial	$462.50
Rate for Payer: Aetna Medicare Advantage	$462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.13
Rate for Payer: Cigna Commercial	$770.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ML

Facility

$2,892.59

Service Code	NDC 9039605
Hospital Charge Code	6063943109
Hospital Revenue Code	250
Min. Negotiated Rate	$376.04
Max. Negotiated Rate	$1,446.30
Rate for Payer: Aetna Commercial	$867.78
Rate for Payer: Aetna Medicare Advantage	$867.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$737.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$737.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$737.61
Rate for Payer: Cigna Commercial	$1,446.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.04
Rate for Payer: Oxford Commercial	$1,446.30
Rate for Payer: Qualcare PPO/HMO/WC	$433.89
Rate for Payer: UnitedHealthcare Commercial	$1,446.30

FLOSEAL HEMOSTATIC MATRIX 10ML

Facility

$2,892.59

Service Code	NDC 9039605
Hospital Charge Code	6063943109
Hospital Revenue Code	250
Min. Negotiated Rate	$433.89
Max. Negotiated Rate	$433.89
Rate for Payer: Qualcare PPO/HMO/WC	$433.89

FLOSEAL HEMOSTATIC MATRIX 5ml

Facility

$842.66

Hospital Charge Code	270626027
Hospital Revenue Code	272
Min. Negotiated Rate	$109.55
Max. Negotiated Rate	$421.33
Rate for Payer: Aetna Commercial	$252.80
Rate for Payer: Aetna Medicare Advantage	$252.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.88
Rate for Payer: Cigna Commercial	$421.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.55
Rate for Payer: Oxford Commercial	$421.33
Rate for Payer: Qualcare PPO/HMO/WC	$126.40
Rate for Payer: UnitedHealthcare Commercial	$421.33

FLOSEAL HEMOSTATIC MATRIX 5ml

Facility

$842.66

Hospital Charge Code	270626027
Hospital Revenue Code	272
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$126.40
Rate for Payer: Qualcare PPO/HMO/WC	$126.40

FLO-SEAL SEALANT

Facility

$280.00

Hospital Charge Code	270335689
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

FLO-SEAL SEALANT

Facility

$280.00

Hospital Charge Code	270335689
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$84.00
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

FLO SWITCH

Facility

$22.56

Hospital Charge Code	270621573
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.28

FLO SWITCH

Facility

$22.56

Hospital Charge Code	270621573
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

FLO SWITCH HP

Facility

$29.38

Hospital Charge Code	270623272N
Hospital Revenue Code	272
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.41

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.28

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.28

FLO SWITCH HP

Facility

$29.38

Hospital Charge Code	270623272N
Hospital Revenue Code	272
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna Commercial	$8.81
Rate for Payer: Aetna Medicare Advantage	$8.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.49
Rate for Payer: Cigna Commercial	$14.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.82
Rate for Payer: Oxford Commercial	$14.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.41
Rate for Payer: UnitedHealthcare Commercial	$14.69

Know your out-of-pocket cost for care.

All Charges