Heights University Hospital

All Charges

Charge

Type

Setting

Price

SEALING DUETT 624227

Facility

$1,000.00

Service Code	HCPCS C1760
Hospital Charge Code	270624227
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SEAL MYSURE

Facility

$51.50

Hospital Charge Code	270664203
Hospital Revenue Code	270
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

SEAL MYSURE

Facility

$51.50

Hospital Charge Code	270664203
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$25.75
Rate for Payer: Aetna Commercial	$15.45
Rate for Payer: Aetna Medicare Advantage	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.13
Rate for Payer: Cigna Commercial	$25.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.70
Rate for Payer: Oxford Commercial	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$25.75

SEALS DISP F/SCOPE WARM C3101

Facility

$19.00

Hospital Charge Code	270641091
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

SEALS DISP F/SCOPE WARM C3101

Facility

$19.00

Hospital Charge Code	270641091
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SEAL SINGLE SITE UNIV

Facility

$75.00

Hospital Charge Code	270677940
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SEAL SINGLE SITE UNIV

Facility

$75.00

Hospital Charge Code	270677940
Hospital Revenue Code	272
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

SEAL UNIVERSAL XI 5-8MM

Facility

$90.00

Hospital Charge Code	270668651
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SEAL UNIVERSAL XI 5-8MM

Facility

$90.00

Hospital Charge Code	270668651
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

SEAL UP II 175070 *********

Facility

$19.00

Hospital Charge Code	1608173
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SEAL UP II 175070 *********

Facility

$19.00

Hospital Charge Code	1608173
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$9.50

SEAMGARD

Facility

$354.00

Hospital Charge Code	270335728
Hospital Revenue Code	278
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$85.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SEAMGARD

Facility

$354.00

Hospital Charge Code	270335728
Hospital Revenue Code	278
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$177.00
Rate for Payer: Aetna Commercial	$106.20
Rate for Payer: Aetna Medicare Advantage	$106.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.27
Rate for Payer: Cigna Commercial	$177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SEAMGUARD

Facility

$600.00

Hospital Charge Code	270605795
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

SEAMGUARD

Facility

$600.00

Hospital Charge Code	270605795
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

SEAMGUARD 45MM

Facility

$975.00

Hospital Charge Code	270672594
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$487.50

SEAMGUARD 45MM

Facility

$975.00

Hospital Charge Code	270672594
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SEAMGUARD 60MM

Facility

$1,090.00

Hospital Charge Code	270672595
Hospital Revenue Code	272
Min. Negotiated Rate	$141.70
Max. Negotiated Rate	$545.00
Rate for Payer: Aetna Commercial	$327.00
Rate for Payer: Aetna Medicare Advantage	$327.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$277.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$277.95
Rate for Payer: Cigna Commercial	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.70
Rate for Payer: Oxford Commercial	$545.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.50
Rate for Payer: UnitedHealthcare Commercial	$545.00

SEAMGUARD 60MM

Facility

$1,090.00

Hospital Charge Code	270672595
Hospital Revenue Code	272
Min. Negotiated Rate	$163.50
Max. Negotiated Rate	$163.50
Rate for Payer: Qualcare PPO/HMO/WC	$163.50

SEAMGUARD BIOABSRB BLK60

Facility

$835.00

Service Code	HCPCS C1781
Hospital Charge Code	270693068
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

SEAMGUARD BIOABSRB BLK60

Facility

$835.00

Service Code	HCPCS C1781
Hospital Charge Code	270693068
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$250.50
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

SEAMGUARD BIOABSRB GRN/BL 60

Facility

$835.00

Service Code	HCPCS C1781
Hospital Charge Code	270693069
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$250.50
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

SEAMGUARD BIOABSRB GRN/BL 60

Facility

$835.00

Service Code	HCPCS C1781
Hospital Charge Code	270693069
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

SEAMGUARD GIA 60 ASG003

Facility

$862.45

Hospital Charge Code	270632269
Hospital Revenue Code	272
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$431.23
Rate for Payer: Aetna Commercial	$258.74
Rate for Payer: Aetna Medicare Advantage	$258.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.92
Rate for Payer: Cigna Commercial	$431.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.12
Rate for Payer: Oxford Commercial	$431.23
Rate for Payer: Qualcare PPO/HMO/WC	$129.37
Rate for Payer: UnitedHealthcare Commercial	$431.23

SEAMGUARD GIA 60 ASG003

Facility

$1,078.80

Hospital Charge Code	270623269
Hospital Revenue Code	278
Min. Negotiated Rate	$161.82
Max. Negotiated Rate	$261.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.07
Rate for Payer: Qualcare PPO/HMO/WC	$161.82

Know your out-of-pocket cost for care.

All Charges