Heights University Hospital

All Charges

Charge

Type

Setting

Price

BAL AMP DE 2.5x80 AME025080152

Facility

$2,025.00

Hospital Charge Code	270636981V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMP DE 2.5x80 AME025080152

Facility

$2,025.00

Hospital Charge Code	270636981V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMP DE 3.5x80 AME035080152

Facility

$2,025.00

Hospital Charge Code	270636985V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMP DE 3.5x80 AME035080152

Facility

$2,025.00

Hospital Charge Code	270636985V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMP DEEP 2x40 AME020040152

Facility

$2,025.00

Hospital Charge Code	270636988V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMP DEEP 2x40 AME020040152

Facility

$2,025.00

Hospital Charge Code	270636988V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMPHI DP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270637203
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMPHI DP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270637203
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMPHI DP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270637203V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$607.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMPHI DP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270637203V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BAL AMPHI DP 4x120AME040120152

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636993
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$457.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BAL AMPHI DP 4x120AME040120152

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636993
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BALANCED SALT OPHT SOL 500ML

Facility

$185.00

Hospital Charge Code	6000533
Hospital Revenue Code	251
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$92.50

BALANCED SALT OPHT SOL 500ML

Facility

$185.00

Hospital Charge Code	6000533
Hospital Revenue Code	251
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

BALANCED SALT SOLIOCARE 500ML

Facility

$459.00

Hospital Charge Code	270331114
Hospital Revenue Code	272
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$68.85
Rate for Payer: Qualcare PPO/HMO/WC	$68.85

BALANCED SALT SOLIOCARE 500ML

Facility

$459.00

Hospital Charge Code	270331114
Hospital Revenue Code	272
Min. Negotiated Rate	$59.67
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna Medicare Advantage	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.05
Rate for Payer: Cigna Commercial	$229.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.67
Rate for Payer: Oxford Commercial	$229.50
Rate for Payer: Qualcare PPO/HMO/WC	$68.85
Rate for Payer: UnitedHealthcare Commercial	$229.50

BALANCED SALT SOLUTION 3ML

Facility

$12.45

Hospital Charge Code	270650487
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

BALANCED SALT SOLUTION 3ML

Facility

$12.45

Hospital Charge Code	270650487
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$6.22
Rate for Payer: Aetna Commercial	$3.73
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$6.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$6.22

BALANCED SALT SOLUTION 500CC

Facility

$64.00

Hospital Charge Code	270331653
Hospital Revenue Code	272
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

BALANCED SALT SOLUTION 500CC

Facility

$64.00

Hospital Charge Code	270331653
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

BAL ATLA PTA 26x4x75cm AT75264

Facility

$2,975.00

Hospital Charge Code	270639796V
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$892.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

BAL ATLA PTA 26x4x75cm AT75264

Facility

$2,975.00

Hospital Charge Code	270639796V
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

BAL IAB 7.5F 25cc 068400047801

Facility

$4,150.00

Service Code	HCPCS C1725
Hospital Charge Code	270634434
Hospital Revenue Code	278
Min. Negotiated Rate	$622.50
Max. Negotiated Rate	$1,004.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$622.50

BAL IAB 7.5F 25cc 068400047801

Facility

$4,150.00

Service Code	HCPCS C1725
Hospital Charge Code	270634434
Hospital Revenue Code	278
Min. Negotiated Rate	$622.50
Max. Negotiated Rate	$2,075.00
Rate for Payer: Aetna Commercial	$1,245.00
Rate for Payer: Aetna Medicare Advantage	$1,245.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,058.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,058.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,058.25
Rate for Payer: Cigna Commercial	$2,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$622.50

BAL IAB 7.5F 25CC 068400047801

Facility

$5,075.00

Hospital Charge Code	270634434C
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,522.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

Know your out-of-pocket cost for care.

All Charges