Heights University Hospital

All Charges

Charge

Type

Setting

Price

SPONGE NEVOS 22X15X05 DEMIN

Facility

$4,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270692489
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,275.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPONGE NEVOS 22X15X05 DEMIN

Facility

$4,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270692489
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPONGE NS 4 X 4 PLY BULK

Facility

$9.53

Hospital Charge Code	270654159
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SPONGE NS 4 X 4 PLY BULK

Facility

$9.53

Hospital Charge Code	270654159
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.76
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna Medicare Advantage	$2.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.76

SPONGE PEANUT 3/8

Facility

$12.85

Hospital Charge Code	270061305
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

SPONGE PEANUT 3/8

Facility

$12.85

Hospital Charge Code	270061305
Hospital Revenue Code	272
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$6.42

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$5.21
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$5.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$5.21

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$318.05
Max. Negotiated Rate	$1,223.25
Rate for Payer: Aetna Commercial	$733.95
Rate for Payer: Aetna Medicare Advantage	$733.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.86
Rate for Payer: Cigna Commercial	$1,223.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.05
Rate for Payer: Oxford Commercial	$1,223.25
Rate for Payer: Qualcare PPO/HMO/WC	$366.98
Rate for Payer: UnitedHealthcare Commercial	$1,223.25

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$366.98
Max. Negotiated Rate	$366.98
Rate for Payer: Qualcare PPO/HMO/WC	$366.98

SPONGE PRE-WASHED STR LAP 4X18

Facility

$6.92

Hospital Charge Code	270648974
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.76
Rate for Payer: Cigna Commercial	$3.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$3.46

SPONGE PRE-WASHED STR LAP 4X18

Facility

$6.92

Hospital Charge Code	270648974
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

SPONGE RAYTEC GAUZE 4X4

Facility

$0.53

Hospital Charge Code	270061520
Hospital Revenue Code	271
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.08

SPONGE RAYTEC GAUZE 4X4

Facility

$0.53

Hospital Charge Code	270061520
Hospital Revenue Code	271
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna Commercial	$0.16
Rate for Payer: Aetna Medicare Advantage	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.14
Rate for Payer: Cigna Commercial	$0.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.07
Rate for Payer: Oxford Commercial	$0.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.08
Rate for Payer: UnitedHealthcare Commercial	$0.27

SPONGES BALLENGER

Facility

$70.35

Hospital Charge Code	270655074
Hospital Revenue Code	270
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

SPONGES BALLENGER

Facility

$70.35

Hospital Charge Code	270655074
Hospital Revenue Code	270
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.17
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$35.17

SPONGE SCERAL SILCONE 3MM

Facility

$300.00

Hospital Charge Code	270331534
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SPONGE SCERAL SILCONE 3MM

Facility

$300.00

Hospital Charge Code	270331534
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$150.00

SPONGES WECK CEL ******

Facility

$4.00

Hospital Charge Code	1600758
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SPONGES WECK CEL ******

Facility

$4.00

Hospital Charge Code	1600758
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SPONGE TONSIL MEDIUM

Facility

$6.81

Hospital Charge Code	270651112
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

SPONGE TONSIL MEDIUM

Facility

$6.81

Hospital Charge Code	270651112
Hospital Revenue Code	272
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.74
Rate for Payer: Cigna Commercial	$3.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.89
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$3.40

SPONGE TONSIL PK LG 10606

Facility

$13.65

Hospital Charge Code	270600312
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

SPONGE TONSIL PK LG 10606

Facility

$13.65

Hospital Charge Code	270600312
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$6.83

SPONGE TONSIL PK MED 10604

Facility

$9.65

Hospital Charge Code	270600313
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

Know your out-of-pocket cost for care.

All Charges