Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEMOSPRAY HEMOSTAT HEMO7

Facility

$12,250.00

Service Code	HCPCS C1052
Hospital Charge Code	270687359
Hospital Revenue Code	272
Min. Negotiated Rate	$1,592.50
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$3,675.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,592.50
Rate for Payer: Oxford Commercial	$6,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Commercial	$6,125.00

HEMOSTAT ABSORBABLE 2X3

Facility

$197.15

Hospital Charge Code	6006357
Hospital Revenue Code	250
Min. Negotiated Rate	$25.63
Max. Negotiated Rate	$98.58
Rate for Payer: Aetna Commercial	$59.15
Rate for Payer: Aetna Medicare Advantage	$59.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.27
Rate for Payer: Cigna Commercial	$98.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.63
Rate for Payer: Oxford Commercial	$98.58
Rate for Payer: Qualcare PPO/HMO/WC	$29.57
Rate for Payer: UnitedHealthcare Commercial	$98.58

HEMOSTAT ABSORBABLE 2X3

Facility

$197.15

Hospital Charge Code	6006357
Hospital Revenue Code	250
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$29.57

HEMOSTAT COSTASIS CSH201

Facility

$1,478.45

Hospital Charge Code	270622962
Hospital Revenue Code	272
Min. Negotiated Rate	$221.77
Max. Negotiated Rate	$221.77
Rate for Payer: Qualcare PPO/HMO/WC	$221.77

HEMOSTAT COSTASIS CSH201

Facility

$1,478.45

Hospital Charge Code	270622962
Hospital Revenue Code	272
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$739.23
Rate for Payer: Aetna Commercial	$443.54
Rate for Payer: Aetna Medicare Advantage	$443.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.00
Rate for Payer: Cigna Commercial	$739.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.20
Rate for Payer: Oxford Commercial	$739.23
Rate for Payer: Qualcare PPO/HMO/WC	$221.77
Rate for Payer: UnitedHealthcare Commercial	$739.23

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$37.36

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$124.53
Rate for Payer: Aetna Commercial	$74.72
Rate for Payer: Aetna Medicare Advantage	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.51
Rate for Payer: Cigna Commercial	$124.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.38
Rate for Payer: Oxford Commercial	$124.53
Rate for Payer: Qualcare PPO/HMO/WC	$37.36
Rate for Payer: UnitedHealthcare Commercial	$124.53

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$77.56
Max. Negotiated Rate	$298.30
Rate for Payer: Aetna Commercial	$178.98
Rate for Payer: Aetna Medicare Advantage	$178.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.13
Rate for Payer: Cigna Commercial	$298.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Oxford Commercial	$298.30
Rate for Payer: Qualcare PPO/HMO/WC	$89.49
Rate for Payer: UnitedHealthcare Commercial	$298.30

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$89.49
Max. Negotiated Rate	$89.49
Rate for Payer: Qualcare PPO/HMO/WC	$89.49

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$114.97
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.82
Rate for Payer: Oxford Commercial	$191.62
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$191.62

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEMOSTREAM EXCHANGE CATHETER

Facility

$808.90

Hospital Charge Code	270654374
Hospital Revenue Code	272
Min. Negotiated Rate	$105.16
Max. Negotiated Rate	$404.45
Rate for Payer: Aetna Commercial	$242.67
Rate for Payer: Aetna Medicare Advantage	$242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.27
Rate for Payer: Cigna Commercial	$404.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.16
Rate for Payer: Oxford Commercial	$404.45
Rate for Payer: Qualcare PPO/HMO/WC	$121.33
Rate for Payer: UnitedHealthcare Commercial	$404.45

HEMOSTREAM EXCHANGE CATHETER

Facility

$808.90

Hospital Charge Code	270654374
Hospital Revenue Code	272
Min. Negotiated Rate	$121.33
Max. Negotiated Rate	$121.33
Rate for Payer: Qualcare PPO/HMO/WC	$121.33

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Oxford Commercial	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$137.50

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Oxford Commercial	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$137.50

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$14.05
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.94
Rate for Payer: Cigna Commercial	$23.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.09
Rate for Payer: Oxford Commercial	$23.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Commercial	$23.41

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

HEMOVAC MED *******

Facility

$139.00

Hospital Charge Code	1600519
Hospital Revenue Code	272
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

HEMOVAC MED *******

Facility

$139.00

Hospital Charge Code	1600519
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.07
Rate for Payer: Oxford Commercial	$69.50
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Commercial	$69.50

HEMOVAC UNIVERSAL CONNECTOR***

Facility

$34.00

Hospital Charge Code	1600592
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$17.00

HEMOVAC UNIVERSAL CONNECTOR***

Facility

$34.00

Hospital Charge Code	1600592
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

Know your out-of-pocket cost for care.

All Charges