Heights University Hospital

All Charges

Charge

Type

Setting

Price

GAYZE XEROFORM STR WRAP 1X8

Facility

$1.60

Hospital Charge Code	270649206
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.80

GBM AB IGG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900098
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GBM AB IGG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900098
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GCT 1 HR

Facility

$390.00

Service Code	HCPCS 82950
Hospital Charge Code	3008498
Hospital Revenue Code	301
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$15.39
Rate for Payer: Aetna Medicare Advantage	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.40
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: Cigna Medicare Advantage	$2.38
Rate for Payer: Clover Medicare Advantage	$4.51
Rate for Payer: EmblemHealth Commercial	$14.25
Rate for Payer: Humana Medicare Advantage	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.04
Rate for Payer: Wellcare Medicare Advantage	$4.75

GCT 1 HR

Facility

$390.00

Service Code	HCPCS 82950
Hospital Charge Code	3008498
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GD CALC FRAC PERCPLT

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686776
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GD CALC FRAC PERCPLT

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686776
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GDE PIN DRL TIP 2.8X300MM STE

Facility

$1,500.00

Hospital Charge Code	270704598
Hospital Revenue Code	279
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

GDE PIN DRL TIP 2.8X300MM STE

Facility

$1,500.00

Hospital Charge Code	270704598
Hospital Revenue Code	279
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

GD PIN SHRT THRD 3.2MM X 14 3P

Facility

$475.00

Hospital Charge Code	270685089
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GD PIN SHRT THRD 3.2MM X 14 3P

Facility

$475.00

Hospital Charge Code	270685089
Hospital Revenue Code	272
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.75
Rate for Payer: Oxford Commercial	$237.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$237.50

GD PIN THD TIP 3.2X 35.5CM

Facility

$288.00

Hospital Charge Code	270624835
Hospital Revenue Code	272
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$86.40
Rate for Payer: Aetna Medicare Advantage	$86.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.44
Rate for Payer: Cigna Commercial	$144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Oxford Commercial	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$144.00

GD PIN THD TIP 3.2X 35.5CM

Facility

$288.00

Hospital Charge Code	270624835
Hospital Revenue Code	272
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

GEL AQUASONIC 100 ULTRASOUND

Facility

$161.00

Hospital Charge Code	270331309
Hospital Revenue Code	272
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

GEL AQUASONIC 100 ULTRASOUND

Facility

$161.00

Hospital Charge Code	270331309
Hospital Revenue Code	272
Min. Negotiated Rate	$20.93
Max. Negotiated Rate	$80.50
Rate for Payer: Aetna Commercial	$48.30
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.93
Rate for Payer: Oxford Commercial	$80.50
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$80.50

GEL AQUASONIC 20G

Facility

$13.78

Hospital Charge Code	270658524
Hospital Revenue Code	270
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$6.89
Rate for Payer: Aetna Commercial	$4.13
Rate for Payer: Aetna Medicare Advantage	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.51
Rate for Payer: Cigna Commercial	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.79
Rate for Payer: Oxford Commercial	$6.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$6.89

GEL AQUASONIC 20G

Facility

$13.78

Hospital Charge Code	270658524
Hospital Revenue Code	270
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

GEL AQUASONIC TRANSMISSION

Facility

$5.24

Hospital Charge Code	270615066
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$1.57
Rate for Payer: Aetna Medicare Advantage	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.34
Rate for Payer: Cigna Commercial	$2.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.68
Rate for Payer: Oxford Commercial	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$2.62

GEL AQUASONIC TRANSMISSION

Facility

$5.24

Hospital Charge Code	270615066
Hospital Revenue Code	270
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

GELATAMINE TAB 4MG

Facility

$9.60

Hospital Charge Code	60629181
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna Medicare Advantage	$2.88
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	$4.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.80

GELATAMINE TAB 4MG

Facility

$9.60

Hospital Charge Code	60629181
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$43.54
Max. Negotiated Rate	$167.47
Rate for Payer: Aetna Commercial	$100.48
Rate for Payer: Aetna Medicare Advantage	$100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.41
Rate for Payer: Cigna Commercial	$167.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.54
Rate for Payer: Oxford Commercial	$167.47
Rate for Payer: Qualcare PPO/HMO/WC	$50.24
Rate for Payer: UnitedHealthcare Commercial	$167.47

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$50.24
Rate for Payer: Qualcare PPO/HMO/WC	$50.24

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$220.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$273.00
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

Know your out-of-pocket cost for care.

All Charges