Heights University Hospital

All Charges

Charge

Type

Setting

Price

MASK FACE FULL LG DISP RTO4OL

Facility

$125.00

Hospital Charge Code	270638050
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

MASK FACE FULL LG DISP RTO4OL

Facility

$125.00

Hospital Charge Code	270638050
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

MASK FACE FULL MED DISP RTO4OM

Facility

$125.00

Hospital Charge Code	270638051
Hospital Revenue Code	272
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$62.50

MASK FACE FULL MED DISP RTO4OM

Facility

$125.00

Hospital Charge Code	270638051
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

MASK FACE HEADGEAR KIT 1010609

Facility

$73.50

Hospital Charge Code	270641265
Hospital Revenue Code	270
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare Advantage	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.74
Rate for Payer: Cigna Commercial	$36.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.55
Rate for Payer: Oxford Commercial	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$11.03
Rate for Payer: UnitedHealthcare Commercial	$36.75

MASK FACE HEADGEAR KIT 1010609

Facility

$73.50

Hospital Charge Code	270641265
Hospital Revenue Code	270
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$11.03
Rate for Payer: Qualcare PPO/HMO/WC	$11.03

MASK FACE PERFORMAX ADULT SM

Facility

$214.25

Hospital Charge Code	270647351
Hospital Revenue Code	272
Min. Negotiated Rate	$27.85
Max. Negotiated Rate	$107.12
Rate for Payer: Aetna Commercial	$64.28
Rate for Payer: Aetna Medicare Advantage	$64.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.63
Rate for Payer: Cigna Commercial	$107.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.85
Rate for Payer: Oxford Commercial	$107.12
Rate for Payer: Qualcare PPO/HMO/WC	$32.14
Rate for Payer: UnitedHealthcare Commercial	$107.12

MASK FACE PERFORMAX ADULT SM

Facility

$214.25

Hospital Charge Code	270647351
Hospital Revenue Code	272
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: Qualcare PPO/HMO/WC	$32.14

MASK FACE SURGICAL ANTIFOG GR

Facility

$343.15

Hospital Charge Code	270655821
Hospital Revenue Code	272
Min. Negotiated Rate	$51.47
Max. Negotiated Rate	$51.47
Rate for Payer: Qualcare PPO/HMO/WC	$51.47

MASK FACE SURGICAL ANTIFOG GR

Facility

$343.15

Hospital Charge Code	270655821
Hospital Revenue Code	272
Min. Negotiated Rate	$44.61
Max. Negotiated Rate	$171.57
Rate for Payer: Aetna Commercial	$102.94
Rate for Payer: Aetna Medicare Advantage	$102.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.50
Rate for Payer: Cigna Commercial	$171.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.61
Rate for Payer: Oxford Commercial	$171.57
Rate for Payer: Qualcare PPO/HMO/WC	$51.47
Rate for Payer: UnitedHealthcare Commercial	$171.57

MASK FACE TENT - AIRLIFE

Facility

$10.45

Hospital Charge Code	270600878
Hospital Revenue Code	272
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

MASK FACE TENT - AIRLIFE

Facility

$10.45

Hospital Charge Code	270600878
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

MASK FACE TENT W/O TENT DISP

Facility

$3.25

Hospital Charge Code	270626228
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$0.98
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Commercial	$1.62

MASK FACE TENT W/O TENT DISP

Facility

$3.25

Hospital Charge Code	270626228
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

MASK FLUIDSHIELD W/SPLSH GUARD

Facility

$58.35

Hospital Charge Code	270649457
Hospital Revenue Code	270
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$29.18
Rate for Payer: Aetna Commercial	$17.50
Rate for Payer: Aetna Medicare Advantage	$17.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.88
Rate for Payer: Cigna Commercial	$29.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Oxford Commercial	$29.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.75
Rate for Payer: UnitedHealthcare Commercial	$29.18

MASK FLUIDSHIELD W/SPLSH GUARD

Facility

$58.35

Hospital Charge Code	270649457
Hospital Revenue Code	270
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.75

MASK FULL FACE LARGE DISP

Facility

$122.73

Hospital Charge Code	270621361
Hospital Revenue Code	272
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

MASK FULL FACE LARGE DISP

Facility

$122.73

Hospital Charge Code	270621361
Hospital Revenue Code	272
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$61.37
Rate for Payer: Aetna Commercial	$36.82
Rate for Payer: Aetna Medicare Advantage	$36.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.30
Rate for Payer: Cigna Commercial	$61.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.95
Rate for Payer: Oxford Commercial	$61.37
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$61.37

MASK FULL FACE LG DISP VENTED

Facility

$108.15

Hospital Charge Code	270652265
Hospital Revenue Code	270
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$54.08
Rate for Payer: Aetna Commercial	$32.45
Rate for Payer: Aetna Medicare Advantage	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.58
Rate for Payer: Cigna Commercial	$54.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.06
Rate for Payer: Oxford Commercial	$54.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.22
Rate for Payer: UnitedHealthcare Commercial	$54.08

MASK FULL FACE LG DISP VENTED

Facility

$108.15

Hospital Charge Code	270652265
Hospital Revenue Code	270
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$16.22
Rate for Payer: Qualcare PPO/HMO/WC	$16.22

MASK FULL FACE MD. 1004849

Facility

$121.45

Hospital Charge Code	270618251
Hospital Revenue Code	272
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Qualcare PPO/HMO/WC	$18.22

MASK FULL FACE MD. 1004849

Facility

$121.45

Hospital Charge Code	270618251
Hospital Revenue Code	272
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$60.73
Rate for Payer: Aetna Commercial	$36.44
Rate for Payer: Aetna Medicare Advantage	$36.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.97
Rate for Payer: Cigna Commercial	$60.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.79
Rate for Payer: Oxford Commercial	$60.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.22
Rate for Payer: UnitedHealthcare Commercial	$60.73

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$17.06

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$56.87
Rate for Payer: Aetna Commercial	$34.12
Rate for Payer: Aetna Medicare Advantage	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.00
Rate for Payer: Cigna Commercial	$56.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.78
Rate for Payer: Oxford Commercial	$56.87
Rate for Payer: Qualcare PPO/HMO/WC	$17.06
Rate for Payer: UnitedHealthcare Commercial	$56.87

MASK FULL FACE PETITE DISP

Facility

$139.35

Hospital Charge Code	270618249
Hospital Revenue Code	272
Min. Negotiated Rate	$18.12
Max. Negotiated Rate	$69.67
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.53
Rate for Payer: Cigna Commercial	$69.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.12
Rate for Payer: Oxford Commercial	$69.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.90
Rate for Payer: UnitedHealthcare Commercial	$69.67

Know your out-of-pocket cost for care.

All Charges