Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MASK MASK COMFORT GEL CUSHION

Facility

$5.00

Hospital Charge Code	270657819
Hospital Revenue Code	270
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

MASK MASK COMFORT GEL CUSHION

Facility

$5.00

Hospital Charge Code	270657819
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MASK MDM PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642447
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

MASK MDM PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642447
Hospital Revenue Code	272
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

MASK MED PERFORMATRAK 1018593

Facility

$117.48

Hospital Charge Code	270647576
Hospital Revenue Code	272
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

MASK MED PERFORMATRAK 1018593

Facility

$117.48

Hospital Charge Code	270647576
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 MULTI LOW CONCENTRATION**

Facility

$7.40

Hospital Charge Code	270600645
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

MASK MULTI LOW CONCENTRATION**

Facility

$7.40

Hospital Charge Code	270600645
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$3.70
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.89
Rate for Payer: Cigna Commercial	$3.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$3.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$3.70

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.95
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna Medicare Advantage	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.77
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$2.95

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

MASK NASAL MED/LG DISP

Facility

$72.31

Hospital Charge Code	270614760
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

MASK NASAL MED/LG DISP

Facility

$72.31

Hospital Charge Code	270614760
Hospital Revenue Code	272
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$36.16
Rate for Payer: Aetna Commercial	$21.69
Rate for Payer: Aetna Medicare Advantage	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.44
Rate for Payer: Cigna Commercial	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.40
Rate for Payer: Oxford Commercial	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$36.16

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$20.49
Rate for Payer: Qualcare PPO/HMO/WC	$20.49

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$17.76
Max. Negotiated Rate	$68.31
Rate for Payer: Aetna Commercial	$40.99
Rate for Payer: Aetna Medicare Advantage	$40.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.84
Rate for Payer: Cigna Commercial	$68.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.76
Rate for Payer: Oxford Commercial	$68.31
Rate for Payer: Qualcare PPO/HMO/WC	$20.49
Rate for Payer: UnitedHealthcare Commercial	$68.31

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$2.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.79
Rate for Payer: Cigna Commercial	$3.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.51

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MASK NON-REBREATHER ADULT

Facility

$16.85

Hospital Charge Code	270600640
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.43

MASK NON-REBREATHER ADULT

Facility

$16.85

Hospital Charge Code	270600640
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

MASK O2 PEDIATRIC 3 IN1

Facility

$278.65

Hospital Charge Code	270653961
Hospital Revenue Code	270
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$41.80

MASK O2 PEDIATRIC 3 IN1

Facility

$278.65

Hospital Charge Code	270653961
Hospital Revenue Code	270
Min. Negotiated Rate	$36.22
Max. Negotiated Rate	$139.32
Rate for Payer: Aetna Commercial	$83.59
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.06
Rate for Payer: Cigna Commercial	$139.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: Oxford Commercial	$139.32
Rate for Payer: Qualcare PPO/HMO/WC	$41.80
Rate for Payer: UnitedHealthcare Commercial	$139.32

MASK OPTICHAMBER MD HS81111

Facility

$26.35

Hospital Charge Code	270635278
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$13.18
Rate for Payer: Aetna Commercial	$7.91
Rate for Payer: Aetna Medicare Advantage	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.72
Rate for Payer: Cigna Commercial	$13.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.43
Rate for Payer: Oxford Commercial	$13.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.95
Rate for Payer: UnitedHealthcare Commercial	$13.18

MASK OPTICHAMBER MD HS81111

Facility

$26.35

Hospital Charge Code	270635278
Hospital Revenue Code	272
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.95

MASK OPTICHAMBER SM HS81211

Facility

$26.85

Hospital Charge Code	270635277
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$13.43
Rate for Payer: Aetna Commercial	$8.05
Rate for Payer: Aetna Medicare Advantage	$8.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.85
Rate for Payer: Cigna Commercial	$13.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.49
Rate for Payer: Oxford Commercial	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.03
Rate for Payer: UnitedHealthcare Commercial	$13.43

MASK OPTICHAMBER SM HS81211

Facility

$26.85

Hospital Charge Code	270635277
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$4.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.03

Know your out-of-pocket cost for care.

All Charges