Heights University Hospital

All Charges

Charge

Type

Setting

Price

GEL CONDUCTIVITY 8OZ

Facility

$11.64

Hospital Charge Code	270649207
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.75

GEL CONDUCTIVITY 8OZ

Facility

$11.64

Hospital Charge Code	270649207
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$5.82
Rate for Payer: Aetna Commercial	$3.49
Rate for Payer: Aetna Medicare Advantage	$3.49
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	$5.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$5.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$5.82

GEL DIFFUSION QUALITATITIVE

Facility

$100.00

Service Code	HCPCS 86331
Hospital Charge Code	3009636B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

GEL DIFFUSION QUALITATITIVE

Facility

$100.00

Service Code	HCPCS 86331
Hospital Charge Code	3009636B
Hospital Revenue Code	302
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

GELFILM 100 X 125MM

Facility

$195.85

Hospital Charge Code	6006746
Hospital Revenue Code	250
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$58.76
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.46
Rate for Payer: Oxford Commercial	$97.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$97.92

GELFILM 100 X 125MM

Facility

$195.85

Hospital Charge Code	6006746
Hospital Revenue Code	250
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

GELFILM ABSORBABLE FILM 1X2 IN

Facility

$111.45

Hospital Charge Code	60629320
Hospital Revenue Code	270
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$55.73
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.42
Rate for Payer: Cigna Commercial	$55.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.49
Rate for Payer: Oxford Commercial	$55.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.72
Rate for Payer: UnitedHealthcare Commercial	$55.73

GELFILM ABSORBABLE FILM 1X2 IN

Facility

$111.45

Hospital Charge Code	60629320
Hospital Revenue Code	270
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$16.72
Rate for Payer: Qualcare PPO/HMO/WC	$16.72

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$132.79
Rate for Payer: Aetna Commercial	$79.68
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.53
Rate for Payer: Oxford Commercial	$132.79
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$132.79

GELFILM OPHTH

Facility

$80.00

Hospital Charge Code	60634788
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

GELFILM OPHTH

Facility

$80.00

Hospital Charge Code	60634788
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$156.78
Max. Negotiated Rate	$156.78
Rate for Payer: Qualcare PPO/HMO/WC	$156.78

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$135.88
Max. Negotiated Rate	$522.60
Rate for Payer: Aetna Commercial	$313.56
Rate for Payer: Aetna Medicare Advantage	$313.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.53
Rate for Payer: Cigna Commercial	$522.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.88
Rate for Payer: Oxford Commercial	$522.60
Rate for Payer: Qualcare PPO/HMO/WC	$156.78
Rate for Payer: UnitedHealthcare Commercial	$522.60

GELFILM OPHTH 25X50MM

Facility

$212.00

Hospital Charge Code	60635611
Hospital Revenue Code	250
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$63.60
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$106.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$106.00

GELFILM OPHTH 25X50MM

Facility

$212.00

Hospital Charge Code	60635611
Hospital Revenue Code	250
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Oxford Commercial	$72.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$72.50

GELFOAM 127MM SPONGE

Facility

$43.00

Hospital Charge Code	60635610
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

GELFOAM 127MM SPONGE

Facility

$43.00

Hospital Charge Code	60635610
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

GELFOAM COMPRESSED/EACH

Facility

$131.00

Hospital Charge Code	60633038
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

GELFOAM COMPRESSED/EACH

Facility

$131.00

Hospital Charge Code	60633038
Hospital Revenue Code	250
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.03
Rate for Payer: Oxford Commercial	$65.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$65.50

GELFOAM/EACH

Facility

$21.00

Hospital Charge Code	60635903
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

GELFOAM/EACH

Facility

$21.00

Hospital Charge Code	60635903
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

GELFOAM SPONGE 50 SQ CM

Facility

$224.05

Service Code	NDC 9032301
Hospital Charge Code	606390182
Hospital Revenue Code	250
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$33.61
Rate for Payer: Qualcare PPO/HMO/WC	$33.61

Know your out-of-pocket cost for care.

All Charges