Heights University Hospital

All Charges

Charge

Type

Setting

Price

PURACOL+COL 4.25x4.5 MSC8644EP

Facility

$199.03

Hospital Charge Code	270640869
Hospital Revenue Code	272
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$29.85
Rate for Payer: Qualcare PPO/HMO/WC	$29.85

PURACOL + COLG 2x2 5 MSC8622EP

Facility

$32.35

Hospital Charge Code	270640868
Hospital Revenue Code	272
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$9.71
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.25
Rate for Payer: Cigna Commercial	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.21
Rate for Payer: Oxford Commercial	$16.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.85
Rate for Payer: UnitedHealthcare Commercial	$16.18

PURACOL + COLG 2x2 5 MSC8622EP

Facility

$32.35

Hospital Charge Code	270640868
Hospital Revenue Code	272
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$4.85
Rate for Payer: Qualcare PPO/HMO/WC	$4.85

PURAPLY AM 6X9 CM

Facility

$13,500.00

Service Code	HCPCS Q4195
Hospital Charge Code	270676741
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PURAPLY AM 6X9 CM

Facility

$13,500.00

Service Code	HCPCS Q4195
Hospital Charge Code	270676741
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PURAPLY AM 6X9 CM/PER SQCM JW

Facility

$560.00

Hospital Charge Code	270676741W
Hospital Revenue Code	636
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

PURAPLY AM 6X9 CM/PER SQCM JW

Facility

$560.00

Hospital Charge Code	270676741W
Hospital Revenue Code	636
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

PURAPLY AM 8X16CM(FULL SHEET)

Facility

$64,000.00

Service Code	HCPCS Q4196
Hospital Charge Code	270689671
Hospital Revenue Code	636
Min. Negotiated Rate	$9,600.00
Max. Negotiated Rate	$15,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,488.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,600.00

PURAPLY AM 8X16CM(FULL SHEET)

Facility

$64,000.00

Service Code	HCPCS Q4196
Hospital Charge Code	270689671
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$19,200.00
Rate for Payer: Aetna Commercial	$19,200.00
Rate for Payer: Aetna Medicare Advantage	$19,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,320.00
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,488.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,600.00

PURAPLY AM PER SQ CM

Facility

$651.25

Service Code	HCPCS Q4172
Hospital Charge Code	270676737P
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$157.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY AM PER SQ CM

Facility

$651.25

Service Code	HCPCS Q4172
Hospital Charge Code	270676737P
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$325.62
Rate for Payer: Aetna Commercial	$195.38
Rate for Payer: Aetna Medicare Advantage	$195.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.07
Rate for Payer: Cigna Commercial	$325.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY AM PER SQ CM

Facility

$3,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676737
Hospital Revenue Code	636
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PURAPLY AM PER SQ CM

Facility

$3,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676737
Hospital Revenue Code	636
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PURAPLY AM PER SQ CM JW

Facility

$651.25

Hospital Charge Code	270676737W
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$325.62
Rate for Payer: Aetna Commercial	$195.38
Rate for Payer: Aetna Medicare Advantage	$195.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.07
Rate for Payer: Cigna Commercial	$325.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY AM PER SQ CM JW

Facility

$651.25

Hospital Charge Code	270676737W
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$157.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY AM PER SQ CM JW

Facility

$651.25

Service Code	HCPCS Q4172JW
Hospital Charge Code	270676737J
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$157.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY AM PER SQ CM JW

Facility

$651.25

Service Code	HCPCS Q4172JW
Hospital Charge Code	270676737J
Hospital Revenue Code	636
Min. Negotiated Rate	$97.69
Max. Negotiated Rate	$325.62
Rate for Payer: Aetna Commercial	$195.38
Rate for Payer: Aetna Medicare Advantage	$195.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.07
Rate for Payer: Cigna Commercial	$325.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.69

PURAPLY WOUND MATRIX 5CM X 5CM

Facility

$6,475.00

Service Code	HCPCS Q4195
Hospital Charge Code	270681826
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

PURAPLY WOUND MATRIX 5CM X 5CM

Facility

$6,475.00

Service Code	HCPCS Q4195
Hospital Charge Code	270681826
Hospital Revenue Code	278
Min. Negotiated Rate	$296.35
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,942.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

PURCHASE REQUEST

Facility

$117.45

Hospital Charge Code	270656347
Hospital Revenue Code	271
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

PURCHASE REQUEST

Facility

$117.45

Hospital Charge Code	270656347
Hospital Revenue Code	271
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$58.73
Rate for Payer: Aetna Commercial	$35.23
Rate for Payer: Aetna Medicare Advantage	$35.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.95
Rate for Payer: Cigna Commercial	$58.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.27
Rate for Payer: Oxford Commercial	$58.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.62
Rate for Payer: UnitedHealthcare Commercial	$58.73

PUREBONE CORTICAL FIBERS 5CC

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696103
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$975.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PUREBONE CORTICAL FIBERS 5CC

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696103
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PURINETHOL/50MG/TAB

Facility

$9.00

Hospital Charge Code	60633786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

PURINETHOL/50MG/TAB

Facility

$9.00

Hospital Charge Code	60633786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

Know your out-of-pocket cost for care.

All Charges