Heights University Hospital

All Charges

Charge

Type

Setting

Price

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$170.75
Rate for Payer: Aetna Commercial	$102.45
Rate for Payer: Aetna Medicare Advantage	$102.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.08
Rate for Payer: Cigna Commercial	$170.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$170.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.23
Rate for Payer: UnitedHealthcare Commercial	$170.75

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$341.50

Service Code	NDC 8290375846
Hospital Charge Code	60628454
Hospital Revenue Code	250
Min. Negotiated Rate	$51.23
Max. Negotiated Rate	$51.23
Rate for Payer: Qualcare PPO/HMO/WC	$51.23

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$14.78
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

OXIDRONATE HDP KIT

Facility

$92.20

Hospital Charge Code	270658214
Hospital Revenue Code	272
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$13.83
Rate for Payer: Qualcare PPO/HMO/WC	$13.83

OXIDRONATE HDP KIT

Facility

$92.20

Hospital Charge Code	270658214
Hospital Revenue Code	272
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$46.10
Rate for Payer: Aetna Commercial	$27.66
Rate for Payer: Aetna Medicare Advantage	$27.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$46.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.99
Rate for Payer: Oxford Commercial	$46.10
Rate for Payer: Qualcare PPO/HMO/WC	$13.83
Rate for Payer: UnitedHealthcare Commercial	$46.10

OXIMETRY*****

Facility

$83.00

Hospital Charge Code	8003493
Hospital Revenue Code	279
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

OXIMETRY*****

Facility

$83.00

Hospital Charge Code	8003493
Hospital Revenue Code	279
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$24.90
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$41.50

OXISENSOR ********

Facility

$40.00

Hospital Charge Code	1801141
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

OXISENSOR ********

Facility

$40.00

Hospital Charge Code	1801141
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$15.31
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.64
Rate for Payer: Oxford Commercial	$25.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$25.52

OXISENSOR ADULT DISP

Facility

$51.04

Hospital Charge Code	270649181
Hospital Revenue Code	272
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$18.16

OXISENSOR II ADULT D25

Facility

$121.05

Hospital Charge Code	270600649
Hospital Revenue Code	272
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$60.52
Rate for Payer: Aetna Commercial	$36.31
Rate for Payer: Aetna Medicare Advantage	$36.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.87
Rate for Payer: Cigna Commercial	$60.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.74
Rate for Payer: Oxford Commercial	$60.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.16
Rate for Payer: UnitedHealthcare Commercial	$60.52

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$9.44
Rate for Payer: Qualcare PPO/HMO/WC	$9.44

OXISENSOR II NEONATAL/ADULT

Facility

$62.96

Hospital Charge Code	270600462
Hospital Revenue Code	270
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$31.48
Rate for Payer: Aetna Commercial	$18.89
Rate for Payer: Aetna Medicare Advantage	$18.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$31.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$31.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.44
Rate for Payer: UnitedHealthcare Commercial	$31.48

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

OXISENSOR INFANT I20

Facility

$124.85

Hospital Charge Code	270600650
Hospital Revenue Code	272
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.23
Rate for Payer: Oxford Commercial	$62.42
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$62.42

OXISENSOR NEONATAL

Facility

$50.61

Hospital Charge Code	270649675
Hospital Revenue Code	270
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$25.30
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna Medicare Advantage	$15.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.91
Rate for Payer: Cigna Commercial	$25.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.58
Rate for Payer: Oxford Commercial	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.59
Rate for Payer: UnitedHealthcare Commercial	$25.30

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OXISENSOR NEONATAL

Facility

$214.00

Hospital Charge Code	270330838
Hospital Revenue Code	272
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$107.00
Rate for Payer: Aetna Commercial	$64.20
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$107.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$107.00

OXISENSOR NEONATAL

Facility

$50.61

Hospital Charge Code	270649675
Hospital Revenue Code	270
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.59

OXISENSOR OXIMAX ADULT

Facility

$39.80

Hospital Charge Code	270649182N
Hospital Revenue Code	270
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$19.90
Rate for Payer: Aetna Commercial	$11.94
Rate for Payer: Aetna Medicare Advantage	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.15
Rate for Payer: Cigna Commercial	$19.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.97
Rate for Payer: UnitedHealthcare Commercial	$19.90

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182S
Hospital Revenue Code	270
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

OXISENSOR OXIMAX ADULT

Facility

$39.80

Hospital Charge Code	270649182N
Hospital Revenue Code	270
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$5.97
Rate for Payer: Qualcare PPO/HMO/WC	$5.97

OXISENSOR OXIMAX ADULT

Facility

$28.95

Hospital Charge Code	270649182
Hospital Revenue Code	270
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.34
Rate for Payer: Qualcare PPO/HMO/WC	$4.34

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All Charges