Heights University Hospital

All Charges

Charge

Type

Setting

Price

PATCH BD HERNIA 8 12 0010201

Facility

$2,882.50

Hospital Charge Code	270623364
Hospital Revenue Code	278
Min. Negotiated Rate	$432.38
Max. Negotiated Rate	$697.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$697.57
Rate for Payer: Qualcare PPO/HMO/WC	$432.38

PATCH BD HERNIA 8 8 0010203

Facility

$2,362.50

Hospital Charge Code	270623794
Hospital Revenue Code	278
Min. Negotiated Rate	$354.38
Max. Negotiated Rate	$571.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$571.73
Rate for Payer: Qualcare PPO/HMO/WC	$354.38

PATCH BD HERNIA 8 8 0010203

Facility

$2,362.50

Hospital Charge Code	270623794
Hospital Revenue Code	278
Min. Negotiated Rate	$354.38
Max. Negotiated Rate	$1,181.25
Rate for Payer: Cigna Commercial	$1,181.25
Rate for Payer: Aetna Commercial	$708.75
Rate for Payer: Aetna Medicare Advantage	$708.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$602.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$602.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$602.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$571.73
Rate for Payer: Qualcare PPO/HMO/WC	$354.38

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$308.75
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$1,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$1,187.50

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$515.00
Rate for Payer: Aetna Commercial	$309.00
Rate for Payer: Aetna Medicare Advantage	$309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.65
Rate for Payer: Cigna Commercial	$515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: Qualcare PPO/HMO/WC	$154.50

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$249.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: Qualcare PPO/HMO/WC	$154.50

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$277.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,012.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PATCH EYE ***********

Facility

$1.00

Hospital Charge Code	8000648
Hospital Revenue Code	279
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

PATCH EYE ***********

Facility

$1.00

Hospital Charge Code	8000648
Hospital Revenue Code	279
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

PATCH FASCIALATA 2X3 93-7200

Facility

$2,261.65

Hospital Charge Code	270613144
Hospital Revenue Code	272
Min. Negotiated Rate	$294.01
Max. Negotiated Rate	$1,130.83
Rate for Payer: Aetna Commercial	$678.50
Rate for Payer: Aetna Medicare Advantage	$678.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.72
Rate for Payer: Cigna Commercial	$1,130.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.01
Rate for Payer: Oxford Commercial	$1,130.83
Rate for Payer: Qualcare PPO/HMO/WC	$339.25
Rate for Payer: UnitedHealthcare Commercial	$1,130.83

PATCH FASCIALATA 2X3 93-7200

Facility

$2,261.65

Hospital Charge Code	270613144
Hospital Revenue Code	272
Min. Negotiated Rate	$339.25
Max. Negotiated Rate	$339.25
Rate for Payer: Qualcare PPO/HMO/WC	$339.25

PATCH GTX 2X9CM 1802009004****

Facility

$140.00

Hospital Charge Code	1604222
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

PATCH GTX 2X9CM 1802009004****

Facility

$140.00

Hospital Charge Code	1604222
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

PATCH GTX SFT TISS1320030020**

Facility

$2,283.00

Hospital Charge Code	1604040
Hospital Revenue Code	278
Min. Negotiated Rate	$342.45
Max. Negotiated Rate	$1,141.50
Rate for Payer: Aetna Commercial	$684.90
Rate for Payer: Aetna Medicare Advantage	$684.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$582.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$582.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$582.16
Rate for Payer: Cigna Commercial	$1,141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.49
Rate for Payer: Qualcare PPO/HMO/WC	$342.45

PATCH GTX SFT TISS1320030020**

Facility

$2,283.00

Hospital Charge Code	1604040
Hospital Revenue Code	278
Min. Negotiated Rate	$342.45
Max. Negotiated Rate	$552.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.49
Rate for Payer: Qualcare PPO/HMO/WC	$342.45

PATCH GTX SOFT TISSUE 5X20CM**

Facility

$1,156.00

Hospital Charge Code	1604032
Hospital Revenue Code	278
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$578.00
Rate for Payer: Aetna Commercial	$346.80
Rate for Payer: Aetna Medicare Advantage	$346.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.78
Rate for Payer: Cigna Commercial	$578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.75
Rate for Payer: Qualcare PPO/HMO/WC	$173.40

PATCH GTX SOFT TISSUE 5X20CM**

Facility

$1,156.00

Hospital Charge Code	1604032
Hospital Revenue Code	278
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$279.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.75
Rate for Payer: Qualcare PPO/HMO/WC	$173.40

PATCH HEMASHLD FINESSE 8x75mm

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270630314
Hospital Revenue Code	272
Min. Negotiated Rate	$65.04
Max. Negotiated Rate	$250.15
Rate for Payer: Aetna Commercial	$150.09
Rate for Payer: Aetna Medicare Advantage	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.58
Rate for Payer: Cigna Commercial	$250.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.04
Rate for Payer: Oxford Commercial	$250.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.05
Rate for Payer: UnitedHealthcare Commercial	$250.15

PATCH HEMASHLD FINESSE 8x75mm

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270630314
Hospital Revenue Code	272
Min. Negotiated Rate	$75.05
Max. Negotiated Rate	$75.05
Rate for Payer: Qualcare PPO/HMO/WC	$75.05

PATCH HFIN 1X3/2.5X7.6 019530

Facility

$722.25

Hospital Charge Code	270630289
Hospital Revenue Code	272
Min. Negotiated Rate	$93.89
Max. Negotiated Rate	$361.12
Rate for Payer: Aetna Commercial	$216.68
Rate for Payer: Aetna Medicare Advantage	$216.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.17
Rate for Payer: Cigna Commercial	$361.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.89
Rate for Payer: Oxford Commercial	$361.12
Rate for Payer: Qualcare PPO/HMO/WC	$108.34
Rate for Payer: UnitedHealthcare Commercial	$361.12

PATCH HFIN 1X3/2.5X7.6 019530

Facility

$722.25

Hospital Charge Code	270630289
Hospital Revenue Code	272
Min. Negotiated Rate	$108.34
Max. Negotiated Rate	$108.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.34

Know your out-of-pocket cost for care.

All Charges