Heights University Hospital

All Charges

Charge

Type

Setting

Price

POVIDONE SOL 10% 946ML

Facility

$32.00

Hospital Charge Code	60628357
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$16.00

POVIDONE SOL OPH 5%

Facility

$79.40

Hospital Charge Code	60628358
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$39.70
Rate for Payer: Aetna Commercial	$23.82
Rate for Payer: Aetna Medicare Advantage	$23.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.25
Rate for Payer: Cigna Commercial	$39.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Oxford Commercial	$39.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.91
Rate for Payer: UnitedHealthcare Commercial	$39.70

POVIDONE SOL OPH 5%

Facility

$79.40

Hospital Charge Code	60628358
Hospital Revenue Code	250
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$11.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.91

POWDER MATRISTEM 100mg WP0100

Facility

$1,600.00

Hospital Charge Code	270644126
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

POWDER MATRISTEM 100mg WP0100

Facility

$1,600.00

Hospital Charge Code	270644126
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$480.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

POWDER STOMAHESIVE

Facility

$37.65

Hospital Charge Code	270303177
Hospital Revenue Code	272
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$11.29
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.89
Rate for Payer: Oxford Commercial	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$18.82

POWDER STOMAHESIVE

Facility

$37.65

Hospital Charge Code	270303177
Hospital Revenue Code	272
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

POWDER SURGICEL 3.0 GM

Facility

$848.13

Hospital Charge Code	270688736
Hospital Revenue Code	272
Min. Negotiated Rate	$127.22
Max. Negotiated Rate	$127.22
Rate for Payer: Qualcare PPO/HMO/WC	$127.22

POWDER SURGICEL 3.0 GM

Facility

$848.13

Hospital Charge Code	270688736
Hospital Revenue Code	272
Min. Negotiated Rate	$110.26
Max. Negotiated Rate	$424.06
Rate for Payer: Aetna Commercial	$254.44
Rate for Payer: Aetna Medicare Advantage	$254.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.27
Rate for Payer: Cigna Commercial	$424.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.26
Rate for Payer: Oxford Commercial	$424.06
Rate for Payer: Qualcare PPO/HMO/WC	$127.22
Rate for Payer: UnitedHealthcare Commercial	$424.06

POWDER TALCUM 90GM

Facility

$37.80

Hospital Charge Code	6005144
Hospital Revenue Code	251
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

POWDER TALCUM 90GM

Facility

$37.80

Hospital Charge Code	6005144
Hospital Revenue Code	251
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

POWER GLIDE PRO FLEX 20 GX 10

Facility

$5,050.00

Service Code	HCPCS C1751
Hospital Charge Code	270680295
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$2,525.00
Rate for Payer: Aetna Commercial	$1,515.00
Rate for Payer: Aetna Medicare Advantage	$1,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,287.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,287.75
Rate for Payer: Cigna Commercial	$2,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

POWER GLIDE PRO FLEX 20 GX 10

Facility

$5,050.00

Service Code	HCPCS C1751
Hospital Charge Code	270680295
Hospital Revenue Code	278
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$1,222.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.10
Rate for Payer: Qualcare PPO/HMO/WC	$757.50

POWERGLIDE PROFLEX TEMP20G10CM

Facility

$290.00

Hospital Charge Code	270686348S
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

POWERGLIDE PROFLEX TEMP20G10CM

Facility

$290.00

Hospital Charge Code	270686348S
Hospital Revenue Code	272
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$87.00
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$145.00

POWERLINK AORTIC EXTENSION

Facility

$15,475.00

Hospital Charge Code	270645895
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

POWERLINK AORTIC EXTENSION

Facility

$15,475.00

Hospital Charge Code	270645895
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$7,737.50
Rate for Payer: Aetna Commercial	$4,642.50
Rate for Payer: Aetna Medicare Advantage	$4,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,946.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,946.12
Rate for Payer: Cigna Commercial	$7,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

POWERLINK AORTIC EXTENSION

Facility

$14,975.00

Hospital Charge Code	270645896
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$7,487.50
Rate for Payer: Aetna Commercial	$4,492.50
Rate for Payer: Aetna Medicare Advantage	$4,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,818.62
Rate for Payer: Cigna Commercial	$7,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

POWERLINK AORTIC EXTENSION

Facility

$14,975.00

Hospital Charge Code	270645896
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$3,623.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

POWERLINK BIFURCATED ENDOGRAPH

Facility

$53,975.00

Hospital Charge Code	270645864
Hospital Revenue Code	278
Min. Negotiated Rate	$8,096.25
Max. Negotiated Rate	$26,987.50
Rate for Payer: Aetna Commercial	$16,192.50
Rate for Payer: Aetna Medicare Advantage	$16,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,763.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,763.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,763.62
Rate for Payer: Cigna Commercial	$26,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,061.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,096.25

POWERLINK BIFURCATED ENDOGRAPH

Facility

$53,975.00

Hospital Charge Code	270645864
Hospital Revenue Code	278
Min. Negotiated Rate	$8,096.25
Max. Negotiated Rate	$13,061.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,061.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,096.25

POWER PICC BARD

Facility

$415.00

Service Code	HCPCS C1751
Hospital Charge Code	270664895
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Aetna Commercial	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

POWER PICC BARD

Facility

$3,780.00

Service Code	HCPCS C1751
Hospital Charge Code	270664895O
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$914.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00

POWER PICC BARD

Facility

$3,780.00

Service Code	HCPCS C1751
Hospital Charge Code	270664895O
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna Commercial	$1,134.00
Rate for Payer: Aetna Medicare Advantage	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$963.90
Rate for Payer: Cigna Commercial	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00

POWER PICC BARD

Facility

$415.00

Service Code	HCPCS C1751
Hospital Charge Code	270664895
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$100.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

Know your out-of-pocket cost for care.

All Charges