Heights University Hospital

All Charges

Charge

Type

Setting

Price

POLYMYXIN BACIT OINT OPH 3.5GM

Facility

$125.45

Hospital Charge Code	6004485
Hospital Revenue Code	251
Min. Negotiated Rate	$16.31
Max. Negotiated Rate	$62.73
Rate for Payer: Aetna Commercial	$37.63
Rate for Payer: Aetna Medicare Advantage	$37.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.99
Rate for Payer: Cigna Commercial	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.31
Rate for Payer: Oxford Commercial	$62.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$62.73

POLYMYXIN BACIT OINT TUB 30GM

Facility

$48.00

Hospital Charge Code	6004477
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

POLYMYXIN BACIT OINT TUB 30GM

Facility

$48.00

Hospital Charge Code	6004477
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

POLYMYXIN BACIT SPRY 90GM

Facility

$37.80

Hospital Charge Code	6004493
Hospital Revenue Code	252
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

POLYMYXIN BACIT SPRY 90GM

Facility

$37.80

Hospital Charge Code	6004493
Hospital Revenue Code	252
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$18.90

POLYMYXIN B SULF IRRG 500,000U

Facility

$52.50

Hospital Charge Code	6004469
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

POLYMYXIN B SULF IRRG 500,000U

Facility

$52.50

Hospital Charge Code	6004469
Hospital Revenue Code	251
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

POLYMYXIN B/TRIMETHOPRIM OPTH

Facility

$442.07

Service Code	NDC 23782410
Hospital Charge Code	60632326
Hospital Revenue Code	250
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$221.03
Rate for Payer: Aetna Commercial	$132.62
Rate for Payer: Aetna Medicare Advantage	$132.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.73
Rate for Payer: Cigna Commercial	$221.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.47
Rate for Payer: Oxford Commercial	$221.03
Rate for Payer: Qualcare PPO/HMO/WC	$66.31
Rate for Payer: UnitedHealthcare Commercial	$221.03

POLYMYXIN B/TRIMETHOPRIM OPTH

Facility

$442.07

Service Code	NDC 23782410
Hospital Charge Code	60632326
Hospital Revenue Code	250
Min. Negotiated Rate	$66.31
Max. Negotiated Rate	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$66.31

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
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

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
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

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
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

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
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

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$77.40
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.54
Rate for Payer: Oxford Commercial	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$129.00

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.66
Rate for Payer: Oxford Commercial	$25.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$25.62

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.66
Rate for Payer: Oxford Commercial	$25.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$25.62

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPRED/5ML

Facility

$84.00

Hospital Charge Code	60635899
Hospital Revenue Code	250
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.92
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$42.00

POLYPRED/5ML

Facility

$84.00

Hospital Charge Code	60635899
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$50.83
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$117.30
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.83
Rate for Payer: Oxford Commercial	$195.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$195.50

Know your out-of-pocket cost for care.

All Charges