Heights University Hospital

All Charges

Charge

Type

Setting

Price

MASK PERFORMAX FACE LG 105532

Facility

$220.00

Hospital Charge Code	270643112
Hospital Revenue Code	270
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$66.00
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$110.00

MASK PERFORMAX LG SPU W/EE

Facility

$214.25

Hospital Charge Code	270644965
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 PERFORMAX LG SPU W/EE

Facility

$214.25

Hospital Charge Code	270644965
Hospital Revenue Code	272
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: Qualcare PPO/HMO/WC	$32.14

MASK PERFORMAX SMALL 1052531

Facility

$175.07

Hospital Charge Code	270650775
Hospital Revenue Code	272
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$26.26
Rate for Payer: Qualcare PPO/HMO/WC	$26.26

MASK PERFORMAX SMALL 1052531

Facility

$175.07

Hospital Charge Code	270650775
Hospital Revenue Code	272
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$87.53
Rate for Payer: Aetna Commercial	$52.52
Rate for Payer: Aetna Medicare Advantage	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.64
Rate for Payer: Cigna Commercial	$87.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.76
Rate for Payer: Oxford Commercial	$87.53
Rate for Payer: Qualcare PPO/HMO/WC	$26.26
Rate for Payer: UnitedHealthcare Commercial	$87.53

MASK PROCEDURE W/FLUID SHIELD

Facility

$70.23

Hospital Charge Code	270301251C
Hospital Revenue Code	270
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$10.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.53

MASK PROCEDURE W/FLUID SHIELD

Facility

$70.23

Hospital Charge Code	270301251C
Hospital Revenue Code	270
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$35.12
Rate for Payer: Aetna Commercial	$21.07
Rate for Payer: Aetna Medicare Advantage	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.91
Rate for Payer: Cigna Commercial	$35.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$35.12
Rate for Payer: Qualcare PPO/HMO/WC	$10.53
Rate for Payer: UnitedHealthcare Commercial	$35.12

MASK RESPIRATOR NEG N95 1870

Facility

$57.63

Hospital Charge Code	270649447
Hospital Revenue Code	272
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$28.82
Rate for Payer: Aetna Commercial	$17.29
Rate for Payer: Aetna Medicare Advantage	$17.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.70
Rate for Payer: Cigna Commercial	$28.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$28.82
Rate for Payer: Qualcare PPO/HMO/WC	$8.64
Rate for Payer: UnitedHealthcare Commercial	$28.82

MASK RESPIRATOR NEG N95 1870

Facility

$57.63

Hospital Charge Code	270649447
Hospital Revenue Code	272
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Qualcare PPO/HMO/WC	$8.64

MASK RESPIRATOR PFR95 REGULAR

Facility

$2.20

Hospital Charge Code	270301254
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.33

MASK RESPIRATOR PFR95 REGULAR

Facility

$2.20

Hospital Charge Code	270301254
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna Commercial	$0.66
Rate for Payer: Aetna Medicare Advantage	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.56
Rate for Payer: Cigna Commercial	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.29
Rate for Payer: Oxford Commercial	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.33
Rate for Payer: UnitedHealthcare Commercial	$1.10

MASK RESPIRATOR PFR95 SMALL

Facility

$2.20

Hospital Charge Code	270301247
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna Commercial	$0.66
Rate for Payer: Aetna Medicare Advantage	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.56
Rate for Payer: Cigna Commercial	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.29
Rate for Payer: Oxford Commercial	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.33
Rate for Payer: UnitedHealthcare Commercial	$1.10

MASK RESPIRATOR PFR95 SMALL

Facility

$2.20

Hospital Charge Code	270301247
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.33

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$25.88
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: Aetna Medicare Advantage	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.20
Rate for Payer: Cigna Commercial	$25.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.73
Rate for Payer: Oxford Commercial	$25.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Commercial	$25.88

MASK SHIELD VISOR FACE

Facility

$5.92

Hospital Charge Code	270649459
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

MASK SHIELD VISOR FACE

Facility

$5.92

Hospital Charge Code	270649459
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$2.96
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.51
Rate for Payer: Cigna Commercial	$2.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.77
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$2.96

MASK SML PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642446
Hospital Revenue Code	272
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

MASK SML PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642446
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

MASKS PKG BOX *******

Facility

$33.00

Hospital Charge Code	8001125
Hospital Revenue Code	279
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.29
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$16.50

MASKS PKG BOX *******

Facility

$33.00

Hospital Charge Code	8001125
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

MASK SURGICAL ANTI-FOG DISP

Facility

$22.96

Hospital Charge Code	270649446
Hospital Revenue Code	270
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$11.48
Rate for Payer: Aetna Commercial	$6.89
Rate for Payer: Aetna Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.85
Rate for Payer: Cigna Commercial	$11.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.98
Rate for Payer: Oxford Commercial	$11.48
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$11.48

MASK SURGICAL ANTI-FOG DISP

Facility

$22.96

Hospital Charge Code	270649446
Hospital Revenue Code	270
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

MASK SURGICAL FACE DISP

Facility

$17.28

Hospital Charge Code	270649456
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$5.18
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.41
Rate for Payer: Cigna Commercial	$8.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$8.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$8.64

MASK SURGICAL FACE DISP

Facility

$17.28

Hospital Charge Code	270649456
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

Know your out-of-pocket cost for care.

All Charges