Heights University Hospital

All Charges

Charge

Type

Setting

Price

GAUZE NU IODO 1/2/5YD

Facility

$9.80

Hospital Charge Code	270300955W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

GAUZE NU IODO 1/2/5YD

Facility

$9.80

Hospital Charge Code	270300955
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

GAUZE NU IODO 1/2/5YD

Facility

$9.80

Hospital Charge Code	270300955
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

GAUZE NU IODO 1/4/ 2 ******

Facility

$68.00

Hospital Charge Code	8001158
Hospital Revenue Code	279
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

GAUZE NU IODO 1/4/ 2 ******

Facility

$68.00

Hospital Charge Code	8001158
Hospital Revenue Code	279
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$34.00
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$34.00

GAUZE NU IODO 1/4/5YD

Facility

$9.62

Hospital Charge Code	270300950W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

GAUZE NU IODO 1/4/5YD

Facility

$9.62

Hospital Charge Code	270300950W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.81
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna Medicare Advantage	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.45
Rate for Payer: Cigna Commercial	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.81

GAUZE NU IODO 1/4 IN /5YD

Facility

$9.62

Hospital Charge Code	270300950
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

GAUZE NU IODO 1/4 IN /5YD

Facility

$9.62

Hospital Charge Code	270300950
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.81
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna Medicare Advantage	$2.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.45
Rate for Payer: Cigna Commercial	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.81

GAUZE NU IODO 1/5YD

Facility

$11.65

Hospital Charge Code	270300960
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.97
Rate for Payer: Cigna Commercial	$5.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$5.83

GAUZE NU IODO 1/5YD

Facility

$11.65

Hospital Charge Code	270300960W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.97
Rate for Payer: Cigna Commercial	$5.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$5.83

GAUZE NU IODO 1/5YD

Facility

$11.65

Hospital Charge Code	270300960W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.75

GAUZE NU IODO 1/5YD

Facility

$11.65

Hospital Charge Code	270300960
Hospital Revenue Code	272
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.75

GAUZE NU IODO 2/5YD

Facility

$16.99

Hospital Charge Code	270300965
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

GAUZE NU IODO 2/5YD

Facility

$16.99

Hospital Charge Code	270300965
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$8.49
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.21
Rate for Payer: Oxford Commercial	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$8.49

GAUZE NU PLAIN 1/4-2 ******

Facility

$10.00

Hospital Charge Code	8001141
Hospital Revenue Code	279
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$5.00

GAUZE NU PLAIN 1/4-2 ******

Facility

$10.00

Hospital Charge Code	8001141
Hospital Revenue Code	279
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

GAUZE NU PLAIN 2/5YD

Facility

$20.85

Hospital Charge Code	270300945
Hospital Revenue Code	272
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

GAUZE NU PLAIN 2/5YD

Facility

$20.85

Hospital Charge Code	270300945
Hospital Revenue Code	272
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$6.25
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$10.43

GAUZE ROLL AMD

Facility

$22.50

Hospital Charge Code	270647397
Hospital Revenue Code	270
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$6.75
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$11.25

GAUZE ROLL AMD

Facility

$22.50

Hospital Charge Code	270647397
Hospital Revenue Code	270
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$6.05
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$6.05

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

Know your out-of-pocket cost for care.

All Charges