Heights University Hospital

All Charges

Charge

Type

Setting

Price

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74115005
Hospital Revenue Code	341
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$682.54
Rate for Payer: Aetna Medicare Advantage	$682.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.16
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.77
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.27
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

GATED HEART PLANNAR SINGLE

Facility

$2,275.12

Service Code	HCPCS 78472
Hospital Charge Code	74115005
Hospital Revenue Code	341
Min. Negotiated Rate	$341.27
Max. Negotiated Rate	$341.27
Rate for Payer: Qualcare PPO/HMO/WC	$341.27

GATIFLOXACIN 400MG/D5W ML IVPB

Facility

$128.00

Service Code	HCPCS S0085
Hospital Charge Code	60629218
Hospital Revenue Code	258
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$64.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$64.00

GATIFLOXACIN 400MG/D5W ML IVPB

Facility

$128.00

Service Code	HCPCS S0085
Hospital Charge Code	60629218
Hospital Revenue Code	258
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

GATIFLOXACIN INJ 400MG

Facility

$213.65

Hospital Charge Code	60629192
Hospital Revenue Code	250
Min. Negotiated Rate	$32.05
Max. Negotiated Rate	$32.05
Rate for Payer: Qualcare PPO/HMO/WC	$32.05

GATIFLOXACIN INJ 400MG

Facility

$213.65

Hospital Charge Code	60629192
Hospital Revenue Code	250
Min. Negotiated Rate	$27.77
Max. Negotiated Rate	$106.83
Rate for Payer: Aetna Commercial	$64.09
Rate for Payer: Aetna Medicare Advantage	$64.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.48
Rate for Payer: Cigna Commercial	$106.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.77
Rate for Payer: Oxford Commercial	$106.83
Rate for Payer: Qualcare PPO/HMO/WC	$32.05
Rate for Payer: UnitedHealthcare Commercial	$106.83

GATIFLOXACIN TAB 200MG

Facility

$40.85

Hospital Charge Code	60629191
Hospital Revenue Code	250
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$12.26
Rate for Payer: Aetna Medicare Advantage	$12.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.42
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.31
Rate for Payer: Oxford Commercial	$20.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$20.43

GATIFLOXACIN TAB 200MG

Facility

$40.85

Hospital Charge Code	60629191
Hospital Revenue Code	250
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

GATIFLOXACIN TAB 400MG

Facility

$58.45

Hospital Charge Code	60629117
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

GATIFLOXACIN TAB 400MG

Facility

$58.45

Hospital Charge Code	60629117
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$29.23
Rate for Payer: Aetna Commercial	$17.54
Rate for Payer: Aetna Medicare Advantage	$17.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.60
Rate for Payer: Oxford Commercial	$29.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$29.23

GAUGE DEPTH 2.0MM/2.4MM screws

Facility

$2,530.25

Hospital Charge Code	270677661
Hospital Revenue Code	272
Min. Negotiated Rate	$328.93
Max. Negotiated Rate	$1,265.12
Rate for Payer: Aetna Commercial	$759.08
Rate for Payer: Aetna Medicare Advantage	$759.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.21
Rate for Payer: Cigna Commercial	$1,265.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.93
Rate for Payer: Oxford Commercial	$1,265.12
Rate for Payer: Qualcare PPO/HMO/WC	$379.54
Rate for Payer: UnitedHealthcare Commercial	$1,265.12

GAUGE DEPTH 2.0MM/2.4MM screws

Facility

$2,530.25

Hospital Charge Code	270677661
Hospital Revenue Code	272
Min. Negotiated Rate	$379.54
Max. Negotiated Rate	$379.54
Rate for Payer: Qualcare PPO/HMO/WC	$379.54

GAUGE DEPTH 2.7/3.5

Facility

$1,509.00

Hospital Charge Code	270672085
Hospital Revenue Code	272
Min. Negotiated Rate	$196.17
Max. Negotiated Rate	$754.50
Rate for Payer: Aetna Commercial	$452.70
Rate for Payer: Aetna Medicare Advantage	$452.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.80
Rate for Payer: Cigna Commercial	$754.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.17
Rate for Payer: Oxford Commercial	$754.50
Rate for Payer: Qualcare PPO/HMO/WC	$226.35
Rate for Payer: UnitedHealthcare Commercial	$754.50

GAUGE DEPTH 2.7/3.5

Facility

$1,509.00

Hospital Charge Code	270672085
Hospital Revenue Code	272
Min. Negotiated Rate	$226.35
Max. Negotiated Rate	$226.35
Rate for Payer: Qualcare PPO/HMO/WC	$226.35

GAUGE MENDEZ DEGREE

Facility

$1,040.00

Hospital Charge Code	270667879
Hospital Revenue Code	272
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.00

GAUGE MENDEZ DEGREE

Facility

$1,040.00

Hospital Charge Code	270667879
Hospital Revenue Code	272
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna Commercial	$312.00
Rate for Payer: Aetna Medicare Advantage	$312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.20
Rate for Payer: Cigna Commercial	$520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.20
Rate for Payer: Oxford Commercial	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.00
Rate for Payer: UnitedHealthcare Commercial	$520.00

GAUGE SHOULDER DEPTH SBDG

Facility

$1,810.45

Hospital Charge Code	270636729
Hospital Revenue Code	272
Min. Negotiated Rate	$235.36
Max. Negotiated Rate	$905.23
Rate for Payer: Aetna Commercial	$543.13
Rate for Payer: Aetna Medicare Advantage	$543.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.66
Rate for Payer: Cigna Commercial	$905.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Oxford Commercial	$905.23
Rate for Payer: Qualcare PPO/HMO/WC	$271.57
Rate for Payer: UnitedHealthcare Commercial	$905.23

GAUGE SHOULDER DEPTH SBDG

Facility

$1,810.45

Hospital Charge Code	270636729
Hospital Revenue Code	272
Min. Negotiated Rate	$271.57
Max. Negotiated Rate	$271.57
Rate for Payer: Qualcare PPO/HMO/WC	$271.57

GAUZE 3X3 BOX ***********

Facility

$49.00

Hospital Charge Code	8000101
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

GAUZE 3X3 BOX ***********

Facility

$49.00

Hospital Charge Code	8000101
Hospital Revenue Code	279
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

GAUZE BETADINE VISCUS EA *****

Facility

$9.00

Hospital Charge Code	8000234
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

GAUZE BETADINE VISCUS EA *****

Facility

$9.00

Hospital Charge Code	8000234
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

GAUZE FINE MESH*********

Facility

$34.00

Hospital Charge Code	8000762
Hospital Revenue Code	279
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

GAUZE FINE MESH*********

Facility

$34.00

Hospital Charge Code	8000762
Hospital Revenue Code	279
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

GAUZE NU IODO 1/2/5YD

Facility

$9.80

Hospital Charge Code	270300955W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$4.90
Rate for Payer: Aetna Commercial	$2.94
Rate for Payer: Aetna Medicare Advantage	$2.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.50
Rate for Payer: Cigna Commercial	$4.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$4.90

Know your out-of-pocket cost for care.

All Charges