Heights University Hospital

All Charges

Charge

Type

Setting

Price

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$5.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.13

POUCH DRAIN INVISICLOSE 2-1/4

Facility

$10.27

Hospital Charge Code	270650524
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

POUCH DRAIN INVISICLOSE 2-1/4

Facility

$10.27

Hospital Charge Code	270650524
Hospital Revenue Code	272
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$5.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.13

POUCH DRBL W/INVISICLOSE 1-3/4

Facility

$4.23

Hospital Charge Code	270610955
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

POUCH DRBL W/INVISICLOSE 1-3/4

Facility

$4.23

Hospital Charge Code	270610955
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.55
Rate for Payer: Oxford Commercial	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$2.12

POUCH IRRIGATION LG 19x24

Facility

$22.85

Hospital Charge Code	270676344
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$11.43
Rate for Payer: Aetna Commercial	$6.86
Rate for Payer: Aetna Medicare Advantage	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.83
Rate for Payer: Cigna Commercial	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.97
Rate for Payer: Oxford Commercial	$11.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.43
Rate for Payer: UnitedHealthcare Commercial	$11.43

POUCH IRRIGATION LG 19x24

Facility

$22.85

Hospital Charge Code	270676344
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.43

POUCH OSTOMY 1ST CHOICE 9763**

Facility

$130.00

Hospital Charge Code	270611249
Hospital Revenue Code	272
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

POUCH OSTOMY 1ST CHOICE 9763**

Facility

$130.00

Hospital Charge Code	270611249
Hospital Revenue Code	272
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.90
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$65.00

POUCH RETRIEVAL BAG 10MM

Facility

$211.36

Hospital Charge Code	270696224
Hospital Revenue Code	272
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$31.70

POUCH RETRIEVAL BAG 10MM

Facility

$211.36

Hospital Charge Code	270696224
Hospital Revenue Code	272
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$105.68
Rate for Payer: Aetna Commercial	$63.41
Rate for Payer: Aetna Medicare Advantage	$63.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.90
Rate for Payer: Cigna Commercial	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.48
Rate for Payer: Oxford Commercial	$105.68
Rate for Payer: Qualcare PPO/HMO/WC	$31.70
Rate for Payer: UnitedHealthcare Commercial	$105.68

POUCHSELF SEALSTR 3-1/2 X8-1/2

Facility

$100.10

Hospital Charge Code	270650937
Hospital Revenue Code	272
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$15.02
Rate for Payer: Qualcare PPO/HMO/WC	$15.02

POUCHSELF SEALSTR 3-1/2 X8-1/2

Facility

$100.10

Hospital Charge Code	270650937
Hospital Revenue Code	272
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$50.05
Rate for Payer: Aetna Commercial	$30.03
Rate for Payer: Aetna Medicare Advantage	$30.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.53
Rate for Payer: Cigna Commercial	$50.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.01
Rate for Payer: Oxford Commercial	$50.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.02
Rate for Payer: UnitedHealthcare Commercial	$50.05

POUCH STERILE INSTRUMENT SK400

Facility

$12.50

Hospital Charge Code	270630137
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$3.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$6.25

POUCH STERILE INSTRUMENT SK400

Facility

$12.50

Hospital Charge Code	270630137
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

POUCH STOMA 4 100MM

Facility

$16.85

Hospital Charge Code	270303171
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$5.05
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.43

POUCH STOMA 4 100MM

Facility

$16.85

Hospital Charge Code	270303171
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

POUCH SUR FIT 2-1/4

Facility

$4.64

Hospital Charge Code	270648540
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

POUCH SUR FIT 2-1/4

Facility

$4.64

Hospital Charge Code	270648540
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2.32
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$2.32

POUCH SURFIT 4 ******

Facility

$47.00

Hospital Charge Code	8002677
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$14.10
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.11
Rate for Payer: Oxford Commercial	$23.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$23.50

POUCH SURFIT 4 ******

Facility

$47.00

Hospital Charge Code	8002677
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

POUCH SURFIT STOMA 1.5-4 BX**

Facility

$213.00

Hospital Charge Code	8001406
Hospital Revenue Code	279
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna Commercial	$63.90
Rate for Payer: Aetna Medicare Advantage	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.31
Rate for Payer: Cigna Commercial	$106.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.69
Rate for Payer: Oxford Commercial	$106.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.95
Rate for Payer: UnitedHealthcare Commercial	$106.50

POUCH SURFIT STOMA 1.5-4 BX**

Facility

$213.00

Hospital Charge Code	8001406
Hospital Revenue Code	279
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$31.95
Rate for Payer: Qualcare PPO/HMO/WC	$31.95

POUCH TYRX

Facility

$4,975.00

Hospital Charge Code	270684099
Hospital Revenue Code	272
Min. Negotiated Rate	$646.75
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,492.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$646.75
Rate for Payer: Oxford Commercial	$2,487.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$2,487.50

Know your out-of-pocket cost for care.

All Charges