Heights University Hospital

All Charges

Charge

Type

Setting

Price

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

GAUZE VASELINE STERILE 1X72

Facility

$2.47

Hospital Charge Code	270649714
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

GAUZE VASELINE STERILE 1X72

Facility

$2.47

Hospital Charge Code	270649714
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.63
Rate for Payer: Cigna Commercial	$1.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.24

GAUZE VASELINE STRIP *******

Facility

$20.00

Hospital Charge Code	8002156
Hospital Revenue Code	279
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

GAUZE VASELINE STRIP *******

Facility

$20.00

Hospital Charge Code	8002156
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Commercial	$1.17
Rate for Payer: Aetna Medicare Advantage	$1.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.99
Rate for Payer: Cigna Commercial	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.51
Rate for Payer: Oxford Commercial	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.59
Rate for Payer: UnitedHealthcare Commercial	$1.95

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Qualcare PPO/HMO/WC	$0.59

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna Commercial	$0.52
Rate for Payer: Aetna Medicare Advantage	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.44
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.23
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.87

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

GAUZE XEROFORM 5X9 *******

Facility

$23.00

Hospital Charge Code	8002180
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

GAUZE XEROFORM 5X9 *******

Facility

$23.00

Hospital Charge Code	8002180
Hospital Revenue Code	279
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$11.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$11.50

GAVISCON-2/TAB

Facility

$3.00

Hospital Charge Code	60633037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

GAVISCON-2/TAB

Facility

$3.00

Hospital Charge Code	60633037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GAVISCON/360ML

Facility

$38.00

Hospital Charge Code	60633035
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

GAVISCON/360ML

Facility

$38.00

Hospital Charge Code	60633035
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

GAVISCON FOAMTAB/TAB

Facility

$3.00

Hospital Charge Code	60633036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

GAVISCON FOAMTAB/TAB

Facility

$3.00

Hospital Charge Code	60633036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GAYZE XEROFORM STR WRAP 1X8

Facility

$1.60

Hospital Charge Code	270649206
Hospital Revenue Code	270
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

Know your out-of-pocket cost for care.

All Charges