Heights University Hospital

All Charges

Charge

Type

Setting

Price

GOWN NON REINFORCED XL

Facility

$12.64

Hospital Charge Code	270649518
Hospital Revenue Code	270
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$6.32
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: Aetna Medicare Advantage	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.22
Rate for Payer: Cigna Commercial	$6.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.64
Rate for Payer: Oxford Commercial	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.90
Rate for Payer: UnitedHealthcare Commercial	$6.32

GOWN OM OR FABRIC DISP 90142

Facility

$16.00

Hospital Charge Code	270600167
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

GOWN OM OR FABRIC DISP 90142

Facility

$16.00

Hospital Charge Code	270600167
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$8.00

GOWN OR ULTRA IMPERV DISP

Facility

$52.00

Hospital Charge Code	270600166
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

GOWN OR ULTRA IMPERV DISP

Facility

$52.00

Hospital Charge Code	270600166
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

GOWN P2 PERSONAL PROTECTION XL

Facility

$4.48

Hospital Charge Code	270653348
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

GOWN P2 PERSONAL PROTECTION XL

Facility

$4.48

Hospital Charge Code	270653348
Hospital Revenue Code	270
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$2.24
Rate for Payer: Aetna Commercial	$1.34
Rate for Payer: Aetna Medicare Advantage	$1.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.58
Rate for Payer: Oxford Commercial	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$2.24

GOWN PEDIATRIC IV 6-8 MEDIUM

Facility

$29.95

Hospital Charge Code	270658806
Hospital Revenue Code	270
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$14.97
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna Medicare Advantage	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.64
Rate for Payer: Cigna Commercial	$14.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.89
Rate for Payer: Oxford Commercial	$14.97
Rate for Payer: Qualcare PPO/HMO/WC	$4.49
Rate for Payer: UnitedHealthcare Commercial	$14.97

GOWN PEDIATRIC IV 6-8 MEDIUM

Facility

$29.95

Hospital Charge Code	270658806
Hospital Revenue Code	270
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.49

GOWN PERSONAL PROTECTION THUMB

Facility

$2.15

Hospital Charge Code	270666707
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.07
Rate for Payer: Aetna Commercial	$0.65
Rate for Payer: Aetna Medicare Advantage	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.55
Rate for Payer: Cigna Commercial	$1.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.28
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.32
Rate for Payer: UnitedHealthcare Commercial	$1.07

GOWN PERSONAL PROTECTION THUMB

Facility

$2.15

Hospital Charge Code	270666707
Hospital Revenue Code	270
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.32

GOWN REINFORCED SURGICAL XLG

Facility

$13.82

Hospital Charge Code	270651535
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$6.91
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: Aetna Medicare Advantage	$4.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$6.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$6.91

GOWN REINFORCED SURGICAL XLG

Facility

$13.82

Hospital Charge Code	270651535
Hospital Revenue Code	270
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

GOWN SPECIALITY

Facility

$21.66

Hospital Charge Code	270653326
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.25

GOWN SPECIALITY

Facility

$21.66

Hospital Charge Code	270653326
Hospital Revenue Code	270
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$10.83
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare Advantage	$6.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.52
Rate for Payer: Cigna Commercial	$10.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.82
Rate for Payer: Oxford Commercial	$10.83
Rate for Payer: Qualcare PPO/HMO/WC	$3.25
Rate for Payer: UnitedHealthcare Commercial	$10.83

GOWN SPECIALTY

Facility

$6.00

Hospital Charge Code	270653293
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

GOWN SPECIALTY

Facility

$6.00

Hospital Charge Code	270653293
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

GOWN SURG FAB REIN DISP *****

Facility

$15.00

Hospital Charge Code	1607068
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

GOWN SURG FAB REIN DISP *****

Facility

$15.00

Hospital Charge Code	1607068
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

GOWN SURGICAL ULTRA XL

Facility

$437.50

Hospital Charge Code	270609214C
Hospital Revenue Code	270
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$218.75
Rate for Payer: Aetna Commercial	$131.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.88
Rate for Payer: Oxford Commercial	$218.75
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$218.75

GOWN SURGICAL ULTRA XL

Facility

$437.50

Hospital Charge Code	270609214C
Hospital Revenue Code	270
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

GOWN ULTRA IMPERV DISP SURG***

Facility

$22.00

Hospital Charge Code	1607076
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

GOWN ULTRA IMPERV DISP SURG***

Facility

$22.00

Hospital Charge Code	1607076
Hospital Revenue Code	272
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$11.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$11.00

GPS MACHINE 7642

Facility

$744.00

Hospital Charge Code	270633005
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

GPS MACHINE 7642

Facility

$744.00

Hospital Charge Code	270633005
Hospital Revenue Code	272
Min. Negotiated Rate	$96.72
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Commercial	$372.00

Know your out-of-pocket cost for care.

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