Heights University Hospital

All Charges

Charge

Type

Setting

Price

GELFOAM SPONGE 50 SQ CM

Facility

$224.05

Service Code	NDC 9032301
Hospital Charge Code	606390182
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$112.03
Rate for Payer: Aetna Commercial	$67.22
Rate for Payer: Aetna Medicare Advantage	$67.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.13
Rate for Payer: Cigna Commercial	$112.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.13
Rate for Payer: Oxford Commercial	$112.03
Rate for Payer: Qualcare PPO/HMO/WC	$33.61
Rate for Payer: UnitedHealthcare Commercial	$112.03

GEL GRAFTON 10CC 121150

Facility

$3,224.00

Hospital Charge Code	270605438
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$967.20
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

GEL GRAFTON 10CC 121150

Facility

$3,224.00

Hospital Charge Code	270605438
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

GEL GRAFTON 1CC 121120

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270601115
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

GEL GRAFTON 1CC 121120

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270601115
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

GEL GRAFTON 1CC 521120

Facility

$704.40

Hospital Charge Code	270622372
Hospital Revenue Code	278
Min. Negotiated Rate	$105.66
Max. Negotiated Rate	$352.20
Rate for Payer: Aetna Commercial	$211.32
Rate for Payer: Aetna Medicare Advantage	$211.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.62
Rate for Payer: Cigna Commercial	$352.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.46
Rate for Payer: Qualcare PPO/HMO/WC	$105.66

GEL GRAFTON 1CC 521120

Facility

$704.40

Hospital Charge Code	270622372
Hospital Revenue Code	278
Min. Negotiated Rate	$105.66
Max. Negotiated Rate	$170.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.46
Rate for Payer: Qualcare PPO/HMO/WC	$105.66

GEL GRAFTON 5CC 121130

Facility

$4,061.65

Hospital Charge Code	270615942
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$982.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

GEL GRAFTON 5CC 121130

Facility

$4,061.65

Hospital Charge Code	270615942
Hospital Revenue Code	278
Min. Negotiated Rate	$609.25
Max. Negotiated Rate	$2,030.83
Rate for Payer: Aetna Commercial	$1,218.49
Rate for Payer: Aetna Medicare Advantage	$1,218.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.72
Rate for Payer: Cigna Commercial	$2,030.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.92
Rate for Payer: Qualcare PPO/HMO/WC	$609.25

GEL GRAFTON 5CC 521130

Facility

$3,690.00

Hospital Charge Code	270622374
Hospital Revenue Code	278
Min. Negotiated Rate	$553.50
Max. Negotiated Rate	$1,845.00
Rate for Payer: Aetna Commercial	$1,107.00
Rate for Payer: Aetna Medicare Advantage	$1,107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$940.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$940.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$940.95
Rate for Payer: Cigna Commercial	$1,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.98
Rate for Payer: Qualcare PPO/HMO/WC	$553.50

GEL GRAFTON 5CC 521130

Facility

$3,690.00

Hospital Charge Code	270622374
Hospital Revenue Code	278
Min. Negotiated Rate	$553.50
Max. Negotiated Rate	$892.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.98
Rate for Payer: Qualcare PPO/HMO/WC	$553.50

GELPOINT PATH

Facility

$4,375.00

Hospital Charge Code	270698635
Hospital Revenue Code	279
Min. Negotiated Rate	$568.75
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.75
Rate for Payer: Oxford Commercial	$2,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Commercial	$2,187.50

GELPOINT PATH

Facility

$4,375.00

Hospital Charge Code	270698635
Hospital Revenue Code	279
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$656.25
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GELPOINT PATH TRANSANAL ACCESS

Facility

$3,625.00

Hospital Charge Code	270676406
Hospital Revenue Code	272
Min. Negotiated Rate	$471.25
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,087.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.25
Rate for Payer: Oxford Commercial	$1,812.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Commercial	$1,812.50

GELPOINT PATH TRANSANAL ACCESS

Facility

$3,625.00

Hospital Charge Code	270676406
Hospital Revenue Code	272
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$543.75
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

GELPORT XE 100MM C8106

Facility

$2,635.00

Hospital Charge Code	270638060
Hospital Revenue Code	272
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$1,317.50
Rate for Payer: Aetna Commercial	$790.50
Rate for Payer: Aetna Medicare Advantage	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$671.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$671.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$671.92
Rate for Payer: Cigna Commercial	$1,317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.55
Rate for Payer: Oxford Commercial	$1,317.50
Rate for Payer: Qualcare PPO/HMO/WC	$395.25
Rate for Payer: UnitedHealthcare Commercial	$1,317.50

GELPORT XE 100MM C8106

Facility

$2,635.00

Hospital Charge Code	270638060
Hospital Revenue Code	272
Min. Negotiated Rate	$395.25
Max. Negotiated Rate	$395.25
Rate for Payer: Qualcare PPO/HMO/WC	$395.25

GEL SILCN 5X6 CICACRE 66250707

Facility

$138.10

Hospital Charge Code	270632955
Hospital Revenue Code	272
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$69.05
Rate for Payer: Aetna Commercial	$41.43
Rate for Payer: Aetna Medicare Advantage	$41.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.22
Rate for Payer: Cigna Commercial	$69.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.95
Rate for Payer: Oxford Commercial	$69.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.71
Rate for Payer: UnitedHealthcare Commercial	$69.05

GEL SILCN 5X6 CICACRE 66250707

Facility

$138.10

Hospital Charge Code	270632955
Hospital Revenue Code	272
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$20.71
Rate for Payer: Qualcare PPO/HMO/WC	$20.71

GEL SOLOSITE WOUND

Facility

$31.51

Hospital Charge Code	270650220
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$15.76
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$9.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.04
Rate for Payer: Cigna Commercial	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.10
Rate for Payer: Oxford Commercial	$15.76
Rate for Payer: Qualcare PPO/HMO/WC	$4.73
Rate for Payer: UnitedHealthcare Commercial	$15.76

GEL SOLOSITE WOUND

Facility

$31.51

Hospital Charge Code	270650220
Hospital Revenue Code	270
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Qualcare PPO/HMO/WC	$4.73

GEL ULTRASOUND AQUASONIC

Facility

$9.30

Hospital Charge Code	270660313
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$4.65
Rate for Payer: Aetna Commercial	$2.79
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Oxford Commercial	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.40
Rate for Payer: UnitedHealthcare Commercial	$4.65

GEL ULTRASOUND AQUASONIC

Facility

$9.30

Hospital Charge Code	270660313
Hospital Revenue Code	270
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.40

GEL WOUND 1.5 OZ

Facility

$84.57

Hospital Charge Code	270685411
Hospital Revenue Code	272
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$42.28
Rate for Payer: Aetna Commercial	$25.37
Rate for Payer: Aetna Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.57
Rate for Payer: Cigna Commercial	$42.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.99
Rate for Payer: Oxford Commercial	$42.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.69
Rate for Payer: UnitedHealthcare Commercial	$42.28

GEL WOUND 1.5 OZ

Facility

$84.57

Hospital Charge Code	270685411
Hospital Revenue Code	272
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$12.69
Rate for Payer: Qualcare PPO/HMO/WC	$12.69

Know your out-of-pocket cost for care.

All Charges