Heights University Hospital

All Charges

Charge

Type

Setting

Price

MASK LARYNGEAL SOFT SEAL #5

Facility

$59.75

Hospital Charge Code	270633313
Hospital Revenue Code	272
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$8.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.96

MASK LARYNGEAL SOFT SEAL #5

Facility

$59.75

Hospital Charge Code	270633313
Hospital Revenue Code	272
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$29.88
Rate for Payer: Aetna Commercial	$17.93
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.24
Rate for Payer: Cigna Commercial	$29.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.77
Rate for Payer: Oxford Commercial	$29.88
Rate for Payer: Qualcare PPO/HMO/WC	$8.96
Rate for Payer: UnitedHealthcare Commercial	$29.88

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna Commercial	$10.19
Rate for Payer: Aetna Medicare Advantage	$10.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.66
Rate for Payer: Cigna Commercial	$16.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$16.98
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$16.98

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$14.60
Rate for Payer: Aetna Commercial	$8.76
Rate for Payer: Aetna Medicare Advantage	$8.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.45
Rate for Payer: Cigna Commercial	$14.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.80
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.38
Rate for Payer: UnitedHealthcare Commercial	$14.60

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.38

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$17.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$17.14

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$20.45
Rate for Payer: Aetna Commercial	$12.27
Rate for Payer: Aetna Medicare Advantage	$12.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.43
Rate for Payer: Cigna Commercial	$20.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Oxford Commercial	$20.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$20.45

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$17.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$17.14

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$27.24
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Oxford Commercial	$45.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$45.40

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: UnitedHealthcare Commercial	$75.00

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #5

Facility

$150.00

Hospital Charge Code	270642547
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

MASK LMA SUPREME #5

Facility

$150.00

Hospital Charge Code	270642547
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LRG PERFORMATRAK 1018594

Facility

$117.48

Hospital Charge Code	270647577
Hospital Revenue Code	272
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

MASK LRG PERFORMATRAK 1018594

Facility

$117.48

Hospital Charge Code	270647577
Hospital Revenue Code	272
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$58.74
Rate for Payer: Aetna Commercial	$35.24
Rate for Payer: Aetna Medicare Advantage	$35.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.96
Rate for Payer: Cigna Commercial	$58.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.27
Rate for Payer: Oxford Commercial	$58.74
Rate for Payer: Qualcare PPO/HMO/WC	$17.62
Rate for Payer: UnitedHealthcare Commercial	$58.74

MASK LRG PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642448
Hospital Revenue Code	272
Min. Negotiated Rate	$19.06
Max. Negotiated Rate	$73.30
Rate for Payer: Aetna Commercial	$43.98
Rate for Payer: Aetna Medicare Advantage	$43.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.38
Rate for Payer: Cigna Commercial	$73.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.06
Rate for Payer: Oxford Commercial	$73.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.99
Rate for Payer: UnitedHealthcare Commercial	$73.30

Know your out-of-pocket cost for care.

All Charges