Heights University Hospital

All Charges

Charge

Type

Setting

Price

MESALAMINE ENEMA 60ML

Facility

$70.40

Hospital Charge Code	6017891
Hospital Revenue Code	252
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$2,454.30
Max. Negotiated Rate	$8,181.00
Rate for Payer: Aetna Commercial	$4,908.60
Rate for Payer: Aetna Medicare Advantage	$4,908.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,172.31
Rate for Payer: Cigna Commercial	$8,181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$2,454.30
Max. Negotiated Rate	$3,959.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30

MESH 206 X 123MM X 06MM

Facility

$8,690.00

Hospital Charge Code	270667196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.50
Max. Negotiated Rate	$2,102.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,738.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,102.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.50

MESH 206 X 123MM X 06MM

Facility

$8,690.00

Hospital Charge Code	270667196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.50
Max. Negotiated Rate	$4,345.00
Rate for Payer: Aetna Commercial	$2,607.00
Rate for Payer: Aetna Medicare Advantage	$2,607.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,215.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,215.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,738.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,215.95
Rate for Payer: Cigna Commercial	$4,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,102.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.50

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$291.71
Max. Negotiated Rate	$470.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: Qualcare PPO/HMO/WC	$291.71

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$291.71
Max. Negotiated Rate	$972.38
Rate for Payer: Aetna Commercial	$583.42
Rate for Payer: Aetna Medicare Advantage	$583.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.91
Rate for Payer: Cigna Commercial	$972.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: Qualcare PPO/HMO/WC	$291.71

MESH 3D MAX 4X6

Facility

$1,500.00

Service Code	HCPCS C1781
Hospital Charge Code	270692643
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

MESH 3D MAX 4X6

Facility

$1,500.00

Service Code	HCPCS C1781
Hospital Charge Code	270692643
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$595.35
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$595.35
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$499.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$1,032.22
Rate for Payer: Aetna Commercial	$619.34
Rate for Payer: Aetna Medicare Advantage	$619.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.43
Rate for Payer: Cigna Commercial	$1,032.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3DMAX MID LG RT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693769
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$499.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3DMAX MID LG RT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693769
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$1,032.22
Rate for Payer: Aetna Commercial	$619.34
Rate for Payer: Aetna Medicare Advantage	$619.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.43
Rate for Payer: Cigna Commercial	$1,032.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3D MAX XL LEFT 7X5IN

Facility

$1,585.00

Service Code	HCPCS C1781
Hospital Charge Code	270693173
Hospital Revenue Code	278
Min. Negotiated Rate	$237.75
Max. Negotiated Rate	$383.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.57
Rate for Payer: Qualcare PPO/HMO/WC	$237.75

MESH 3D MAX XL LEFT 7X5IN

Facility

$1,585.00

Service Code	HCPCS C1781
Hospital Charge Code	270693173
Hospital Revenue Code	278
Min. Negotiated Rate	$237.75
Max. Negotiated Rate	$792.50
Rate for Payer: Aetna Commercial	$475.50
Rate for Payer: Aetna Medicare Advantage	$475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.18
Rate for Payer: Cigna Commercial	$792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.57
Rate for Payer: Qualcare PPO/HMO/WC	$237.75

MESH 3D MAX XL RIGHT 7X5IN

Facility

$1,585.00

Service Code	HCPCS C1781
Hospital Charge Code	270693174
Hospital Revenue Code	278
Min. Negotiated Rate	$237.75
Max. Negotiated Rate	$792.50
Rate for Payer: Aetna Commercial	$475.50
Rate for Payer: Aetna Medicare Advantage	$475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.18
Rate for Payer: Cigna Commercial	$792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.57
Rate for Payer: Qualcare PPO/HMO/WC	$237.75

MESH 3D MAX XL RIGHT 7X5IN

Facility

$1,585.00

Service Code	HCPCS C1781
Hospital Charge Code	270693174
Hospital Revenue Code	278
Min. Negotiated Rate	$237.75
Max. Negotiated Rate	$383.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.57
Rate for Payer: Qualcare PPO/HMO/WC	$237.75

MESH 3D MID LEFT XL

Facility

$2,285.00

Service Code	HCPCS C1781
Hospital Charge Code	270694711
Hospital Revenue Code	278
Min. Negotiated Rate	$342.75
Max. Negotiated Rate	$1,142.50
Rate for Payer: Aetna Commercial	$685.50
Rate for Payer: Aetna Medicare Advantage	$685.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$457.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.67
Rate for Payer: Cigna Commercial	$1,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.97
Rate for Payer: Qualcare PPO/HMO/WC	$342.75

MESH 3D MID LEFT XL

Facility

$2,285.00

Service Code	HCPCS C1781
Hospital Charge Code	270694711
Hospital Revenue Code	278
Min. Negotiated Rate	$342.75
Max. Negotiated Rate	$552.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$457.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.97
Rate for Payer: Qualcare PPO/HMO/WC	$342.75

Know your out-of-pocket cost for care.

All Charges