Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
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	$54.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
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

GLOMERULAR BASEMENT MEMBRAME

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3007608
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	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
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

GLOMERULAR BASEMENT MEMBRAME

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3007608
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

GLOVE ANSELL RADIATION SZ 7.5

Facility

$164.80

Hospital Charge Code	270640124
Hospital Revenue Code	272
Min. Negotiated Rate	$24.72
Max. Negotiated Rate	$24.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.72

GLOVE ANSELL RADIATION SZ 7.5

Facility

$164.80

Hospital Charge Code	270640124
Hospital Revenue Code	272
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$82.40
Rate for Payer: Aetna Commercial	$49.44
Rate for Payer: Aetna Medicare Advantage	$49.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.02
Rate for Payer: Cigna Commercial	$82.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.42
Rate for Payer: Oxford Commercial	$82.40
Rate for Payer: Qualcare PPO/HMO/WC	$24.72
Rate for Payer: UnitedHealthcare Commercial	$82.40

GLOVE ANSELL RADIATION SZ 8

Facility

$142.05

Hospital Charge Code	270658537
Hospital Revenue Code	272
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$71.03
Rate for Payer: Aetna Commercial	$42.62
Rate for Payer: Aetna Medicare Advantage	$42.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.22
Rate for Payer: Cigna Commercial	$71.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.47
Rate for Payer: Oxford Commercial	$71.03
Rate for Payer: Qualcare PPO/HMO/WC	$21.31
Rate for Payer: UnitedHealthcare Commercial	$71.03

GLOVE ANSELL RADIATION SZ 8

Facility

$142.05

Hospital Charge Code	270658537
Hospital Revenue Code	272
Min. Negotiated Rate	$21.31
Max. Negotiated Rate	$21.31
Rate for Payer: Qualcare PPO/HMO/WC	$21.31

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$72.75
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.52
Rate for Payer: Oxford Commercial	$121.25
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$121.25

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

GLOVE ESTEEM STERILE SZ7

Facility

$8.17

Hospital Charge Code	270060930C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$1.23

GLOVE ESTEEM STERILE SZ7

Facility

$8.17

Hospital Charge Code	270060930C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$4.08
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna Medicare Advantage	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.08
Rate for Payer: Cigna Commercial	$4.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.06
Rate for Payer: Oxford Commercial	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.23
Rate for Payer: UnitedHealthcare Commercial	$4.08

GLOVE ESTEEM SURGICAL PF SZ6.5

Facility

$317.35

Hospital Charge Code	270654289
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$47.60
Rate for Payer: Qualcare PPO/HMO/WC	$47.60

GLOVE ESTEEM SURGICAL PF SZ6.5

Facility

$317.35

Hospital Charge Code	270654289
Hospital Revenue Code	270
Min. Negotiated Rate	$41.26
Max. Negotiated Rate	$158.68
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna Medicare Advantage	$95.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.92
Rate for Payer: Cigna Commercial	$158.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.26
Rate for Payer: Oxford Commercial	$158.68
Rate for Payer: Qualcare PPO/HMO/WC	$47.60
Rate for Payer: UnitedHealthcare Commercial	$158.68

GLOVE ESTEEM SZ 6

Facility

$79.34

Hospital Charge Code	270654287
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$11.90
Rate for Payer: Qualcare PPO/HMO/WC	$11.90

GLOVE ESTEEM SZ 6

Facility

$79.34

Hospital Charge Code	270654287
Hospital Revenue Code	270
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$39.67
Rate for Payer: Aetna Commercial	$23.80
Rate for Payer: Aetna Medicare Advantage	$23.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.23
Rate for Payer: Cigna Commercial	$39.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Oxford Commercial	$39.67
Rate for Payer: Qualcare PPO/HMO/WC	$11.90
Rate for Payer: UnitedHealthcare Commercial	$39.67

GLOVE EXAM NITRILE LG POWDR/LF

Facility

$31.26

Hospital Charge Code	270649549
Hospital Revenue Code	270
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$15.63
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$15.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$15.63

GLOVE EXAM NITRILE LG POWDR/LF

Facility

$31.26

Hospital Charge Code	270649549
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

GLOVE EXAM NITRILE MED POWD/LF

Facility

$31.26

Hospital Charge Code	270649550
Hospital Revenue Code	270
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$15.63
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$15.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$15.63

GLOVE EXAM NITRILE MED POWD/LF

Facility

$31.26

Hospital Charge Code	270649550
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

GLOVE EXAM NITRILE STER LG

Facility

$0.14

Hospital Charge Code	270649551
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.02

GLOVE EXAM NITRILE STER LG

Facility

$0.14

Hospital Charge Code	270649551
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna Commercial	$0.04
Rate for Payer: Aetna Medicare Advantage	$0.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.04
Rate for Payer: Cigna Commercial	$0.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.02
Rate for Payer: Oxford Commercial	$0.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.02
Rate for Payer: UnitedHealthcare Commercial	$0.07

GLOVE EXAM SYNTHETIC LG

Facility

$20.25

Hospital Charge Code	270649765
Hospital Revenue Code	270
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

GLOVE EXAM SYNTHETIC LG

Facility

$20.25

Hospital Charge Code	270649765
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.16
Rate for Payer: Cigna Commercial	$10.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.63
Rate for Payer: Oxford Commercial	$10.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$10.12

GLOVE EXAM SYNTHETIC SM

Facility

$13.50

Hospital Charge Code	270649764
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare Advantage	$4.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.44
Rate for Payer: Cigna Commercial	$6.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$6.75

Know your out-of-pocket cost for care.

All Charges